What Are The Main Differences Between Ptsd And Complex Ptsd?

[Justmehere]

People have referenced trauma causing alterations in genes during this discussion. I'm kind of curious about that. Can anyone give me a link or 2 so I can read more about it? Do you means turning genes on or off within cells, or the kind of genetic changes that can actually be transmitted?

This might help address your question – from: http://science.howstuffworks.com/ptsd2.htm (where further links to original sources can be found)

“There is also some emerging evidence that PTSD may occur on a genetic level. One gene being looked at is the serotonin transporter gene. A paper indicated that mutations in this gene can have an impact on attention to environmental threats, suggesting that if certain people have a hard time modulating attention to threat in the environment (for instance through hypervigilance) they may be more prone to PTSD [source: Wald et al].”

“Another study suggests that PTSD may be the result of epigenetics – changes to the function of genes that can happen in a lifetime. A 2009 study of Detroit residents showed that those who fit the criteria for a PTSD diagnosis had six to seven times the regular amount of epigenetic changes to their genes of those in the control group. Most of the genes that had undergone epigenetic change were responsible for immune system function [source: Uddin, et al].”

That all being said, the article continues on to point out,

“However, the most important factor in the development (or not) of PTSD is the existence of a strong social support network. Time and again, people who have close relationships with those around them have been shown to be much less likely to develop PTSD and more likely to recover from it.”

As for if the trauma can affect genes passed to the next generation, there is some interesting studies coming out on that. The simple answer is not really a yes or no, but kind of.

This study was done in mice: Dead Link Removed
Basically, traumatized mice developed changes in microRNA expression and this was passed on even the third generation, and the affected generations of mice showed behavioral changes to avoid traumatic triggers, even though they were never traumatized.

There have been human studies as well:
Dead Link Removed
“Dr. Isabelle Mansuy and colleagues provide new evidence in the current issue of Biological Psychiatry that some aspects of the impact of trauma cross generations and are associated with epigenetic changes, i.e., the regulation of the pattern of gene expression, without changing the DNA sequence.”

I have a list of other studies and articles done on this subject – but these two articles above touch on the subject pretty well without getting super bogged down in technical details that get really muddled and confusing.

The intergenerational impact of PTSD and trauma is something I have looked into quite a bit. I am the product of three generations of people with PTSD in my family. Both my living grandparents on both sides of my family were diagnosed with PTSD later in life, and both of my own parents as well, and now myself. All three generations have experience trauma first hand, but there are also things that were passed on behaviorally - - i.e. my parents learned certain behaviors from their grandparents - - and I also wonder if the epigenetic effects (the degree to which certain genes are expressed or not expressed) of trauma has been passed on as well through the generations too. These studies seem to indicate that this is possible.

 

[anthony]

Anthony why do you see DESNOS as like what others see as CPTSD?

Because they're actually the same diagnosis. Hermans existing proposal of diagnostic symptoms and clusters was Van der Kolks continuing work. Herman stopped a lot of her work, and Van der Kolk picked up turning it towards DESNOS, as CPTSD was failing viability in proposals. Both failed overall though for getting a complex trauma diagnosis recognised, unfortunately...

Read Hermans and Van der Kolks proposed clusters, and they're near identical in overall syptomology. Both are about a part PTSD + BPD + Dissociation approach.

 

[anthony]

IMHO, most of these arguments about diagnosis dilution comes down to both societies demands on having labels if you only borderline a diagnosis + the therapeutic model now being more business oriented than well-being oriented. There is a lot to blame in both areas, society and therapists just being greedy.

 

[Butterflywings]

@junglegirl even if you can't see the lack of understanding of your aspie friend is offensive, your sweeping generalisations about aspies IS incredibly offensive.

It's a shame you find calling you out on your offensive comments as a "personal attack". The rest of the world calls it standing up to those who perpetuate untrue stereotypes about minority groups.

I do respond to personal attacks. My post was long but completely appropriate.

And of course it affects a person's character to have no empathy.

But we're back to your bigotry about aspies. Let me put it really short and simple for you: PEOPLE WITH ASPERGERS DO NOT LACK EMPATHY.

Having aspergers does NOT affect character because having aspergers is not linked to a lack of empathy. Is that short and direct enough for you?

You show no empathy for people with aspergers and you perpetuate the myth that they lack empathy despite the fact that research has repeatedly shown they do not lack empathy at all - that in fact they are hyper-empathetic.

I can't fix your incorrect thinking about aspies, but I would ask you please refrain from insulting aspies and offending everyone who is one or loves one.

 

[Butterflywings]

It's impossible to get anyone with aspergers to change their minds. Those with borderline cannot possibly be as high functioning as you.

I am sorry, but I have personally experienced both of these "examples" to be incorrect. Thus, they are sweeping generalizations or stereotypes which are not true for all experiencing such disorders, respectively.

Solara do you honestly believe it's not possible to ever change anyone with aspergers' minds ever? Of course you can get an aspie to change their mind if you can show them with logic as to why they should change their mind.

As for someone with BPD not being as high functioning as me, you've misunderstood. How many people here can work effectively when their symptoms are severe and/or unstable? When my depression/mania/PTSD symptoms are at their worst, I am not high functioning. But I do have years of high functioning in between where I am virtually symptom free. The definition of BPD is that it's not episodic so there aren't episodes of it broken up by years of high functioning in between. I have met a lot of people with BPD both professionally and personally, and by definition of what BPD is, a person with it is too hyper sensitive to cope in certain fields. I'll reply more to the other post I just read to explain more...

 

[Butterflywings]

Justmehere I think we have a different view of what "remission" means. Speak to anyone with BPD who is considered to be in remission and they will explain that their symptoms never fully go away. Yes it's very accurate to say " As individuals with BPD age, their symptoms and/or the severity of the illness usually diminish. " They are considered in remission because their symptoms are not enough to meet the severity and number of symptoms required for a diagnosis of BPD, but just speak to any sufferer and they will explain that they still have symptoms, just not as severe. It's a logarithmic curve that may approach zero but never reaches zero. Someone with bipolar for example is more like a type of sin curve (sorry can't think of it's name and just asked my dad who is a high school maths teacher and can't think of the name of it - it's where there is a curve, followed by a flat section, followed by another curve, then another flat section... which I could draw a pic on here) and theyhave periods where symptoms flare up extremely, then are zero, then flare up again etc.

I don't think people with it are beyond help at all. I think it can be like some anxiety disorders - where with therapy (for some that is psychotherapy, for some it is meds, for some it is both), that the symptoms can reduce to the point where the person can live a pretty normal life. But like anxiety, there may be some limitations. For example, my social anxiety is under control except when I am depressed. But when I say it's under control, I'm never going to be able to take up public speaking every day. Part of remission of any mental health condition is understanding your limits - part of any healthy living for every human being actually is knowing your limits.

From the Sane Australia website (and from just about every other thing I could find wrote something similar): "People with BPD can get better. Contrary to common belief, people with BPD can recover well with appropriate ongoing treatment and support. While there is no cure yet, BPD is a treatable disorder."

No cure means it's permanent. Treatable means it is manageable condition and what they are saying is, with ongoing treatment and support, the person can live a pretty normal life. It's like type 2 diabetes... you cannot cure it, but you can treat it so well that it doesn't impact your life negatively while following your treatment regime. It definition can get better, to the point where if the person was seeing a professional for the first time with that level of symptoms, they would not meet the criteria for BPD anymore, but they still have symptoms, just not as many and not as severe.

Perhaps talk to some people with BPD who are considered to be in remission? They could explain it better than me from a personal level. But the overwhelming thing I've heard from them is the emotional hypersensitivity never goes away, they just have learnt not to respond to it in the destructive ways that qualifies a diagnosis.

So I agree with you that it can go into remission, just that my definition of remission appears different from yours. Mainly because I've spoken to a lot of people who are considered to be in remission (we get people with "lived experiences of mental illness" come to give us talks as part of our core professional professional development talks on a regular basis... on a side note I just saw earlier tonight the department who runs it is looking for people with PTSD to volunteer and I've applied for it. The people who are in remission from schizophrenia are the most interesting, but I'm getting off topic). As mentioned, those I've met who are diagnosed as in remission still have that underlying emotional sensitivity but just have learnt how to cope with it.

The relationship to aspergers in the previous conversations is that aspies are hypersensitive to emotions to and that's why a lot of female aspies accidently get misdiagnosed as having borderline PD.

And while it's not the worst thing in the world to suffer from, just speak to most sufferers and they'll say it's one of the worst things to suffer from. I've been told by many people it's like being born with no skin emotionally - that it's worse than being thin skinned, that it's like having no skin at all. A lady with it who I was talking to last night reminded me of that metaphor for it. It has one of the highest suicide rates of any mental illness. Isn't the suicide rate enough to classify it as one of the reasons to consider it amongst the least wanted illness?

It depends on a person's definition of "worst". I think "worst mental illness" is entirely an individual thing and mental illnesses can never be ranked outside of what each individual would find worse for them. For me personally, I think narcissistic or antisocial PDs are the "worst" because they are a lack of care for other people. I'd rather totally lose my mind than to enjoy being cruel to other people. There are other people who would say they think NPD or ASPD aren't that bad at all because "sufferers" don't really suffer themselves (just everyone around them does).

There is one last comment that a workmate said to me a few months about BPD that I thought I would share and that's basically the reason why so many people with BPD go into remission (ie remission defined as symptoms decreased to a manageable level, but not ever fully going away) is because of the high suicide rate. By middle age, everyone with BPD has either learned to live with it or are dead or permanently seriously disabled from suicide attempts. Those who have survived, are those who have learnt coping skills to effectively manage it.

Hoping that makes sense.

 

[Butterflywings]

Asperger's is no longer a diagnosis in the DSM 5. It was a diagnosis in the DSM 4. Perhaps to get everyone on the same page... let's look at the actual criteria for Asperger's rather than just going off of anecdotal stories alone about people who had Aspergers and other conditions.

Yep it's just lumped in as autistic spectrum disorder now. That's one of the ways in which the DSM-5 is somewhat lacking - not sufficiently differentiating high functioning autism (formerly known as aspergers) from low functioning autism (formerly known as "autism" or classic autism). Most people who are adults with it aren't going to go through a whole re-diagnosis process just to get the new name and still refer to what their diagnosis was at the time they got it which is aspergers.

With my daughter, the specialists she was seeing had already switched over to the new criteria so she is officially diagnosed as having autistic spectrum disorder (high functioning type). But a lot of the general public has no idea what is being talked about when you say "my kid has ASD". They do understand (mostly) what aspergers is and all the books for general public use still call it aspergers. I personally like Rudy Simone's books as they describe aspergers as it shows in women, very well.

 

[Butterflywings]

And, going back to the ability to get better with BPD, this article later on states:

“Some symptoms of borderline personality disorder may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent.34 People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder.4 However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent of people with borderline personality disorder had a relapse after remission.4”

That all being said, it is dangerous when any of us a group of people and characterizing them on the basis of their worst or best examples. It's like if someone said all people with PTSD are violent, because a couple of people with PTSD have killed others. That kind of statement would probably upset most everyone here. (And here I am making generalizations myself!).

Justmehere ... sorry I used the description "types" instead of just saying types (no " ") to infer that it's still all PTSD just that generally different traumas generally have clusters of symptoms that go with that trauma type. It can help in the treatment of PTSD to recognise the impact of types of traumas and that different traumas can have subtly different expressions. Similarly to how bipolar is bipolar but there is a huge difference between a person who mostly has manic episodes or a person who has mostly depressive episodes. It's not a legal label, but saying if a bipolar person is more a manic type or depressive type can be very useful in working out what treatments may be best.. Sorry if that wasn't clear.

I think what you wrote that I just quoted sums up what I'm trying to say about BPD "relapse, or the recurrence of full-blown symptoms after remission, is rare." Full blown symptoms do not come back after remission, but the underlying less severe symptoms never full go away. I would consider that only partial remission not full remission.

I think what I said about aspies and changing their mind has been taken out of context. No one will get an aspie to change their mind without appealing to their logical side. The whole thing with those poor cats... no one will change the guy's mind by telling him he's wrong about throwing his cats in the rubbish because it's disrespectful. But appeal to him using logic (it's a health hazard, it's not safe disposal etc)... then you'll get him to change his mind.

Temple Grandin is a good example... I bet she wouldn't change her mind about social expectation just because someone told her "oh that's not socially appropriate". I know from dealing with my lovable but stubborn husband, the only way to get him to change his mind on something is to appeal to his logic side. If you can show him logically why is wrong, he'll change his mind (although it might take him a few days to actually admit it). I wasn't meaning to say aspies never change their mind - just if you want them to change their mind, generally (not always) you need to approach them with logic.

And your last bit that I've quoted... thanks... that's what I've been trying to express just not as well as you have. I usually jump on here in the early hours of the morning before I do my daughter's 4am feed so it's not my best writing.

 

[Justmehere]

Justmehere I think we have a different view of what "remission" means.

" As individuals with BPD age, their symptoms and/or the severity of the illness usually diminish. "

These are not really my opinions per say. You have a differing viewpoint than those who research the illness like Harvard and the NIH and others that I cited.

It is my understanding that they use remission to means no longer meeting the diagnostic criteria and no longer having a mental illness.
Here is a definition from the Merriam-Webster dictionary as to what remission means:
"Medical Definition of Remission
: a state or period during which the symptoms of a disease are abated <cancer in remission after treatment>—compare arrest, cure 1, intermission."
That is how I am using the term and how I believe the researchers are. When someone's symptoms are so reduced they don't qualify for a diagnosis, I think it's safe to say that is a fully remission of a disease if they can't be diagnosed with the disease anymore.

It seems to be your position that someone can still be mentally ill with BPD, have "partial remission" and yet also somehow also not qualify for the diagnosis of BPD at the same time...? That gets into labeling people with mental illnesses for being within normal limits, in which case, I would guess most of the population of humanity would then be considered mentally ill.

It appears feel the studies were deeply flawed in how they evaluated remission of BPD. Can you give me some specific examples backed up in research that it is impossible to have full remission from BPD as you so adamantly declare?

I think it can be like some anxiety disorders - where with therapy (for some that is psychotherapy, for some it is meds, for some it is both), that the symptoms can reduce to the point where the person can live a pretty normal life. But like anxiety, there may be some limitations. For example, my social anxiety is under control except when I am depressed. But when I say it's under control, I'm never going to be able to take up public speaking every day. Part of remission of any mental health condition is understanding your limits - part of any healthy living for every human being actually is knowing your limits.

If a mental health problem is still limiting you because of symptoms you have to work to control, then it is not in remission.

Saying you have a condition that is under control is one thing. Saying the condition is in remission, is another.

If I am controlling diabetes, then I still have diabetes. I can control it with diet and insulin, but the disease process is still there. If my diabetes is in remission, then I no longer need to control it. The disease is no longer there to control.

Limits vary for every person. I have social anxiety, but I do public speaking. My anxiety is not in remission, but I control it enough to be able to do public speaking. When my anxiety is in remission, I don't need to work to control it.

Anxiety disorders can go into remission for some people. I used to have a fear of swimming in lakes. I had to do a lot of things to control the fear. Then I got treatment and the fear went into remission. I no longer have a fear of swimming in lakes, I don't have to do anything to control it. It's not there anymore.

There is one last comment that a workmate said to me a few months about BPD that I thought I would share and that's basically the reason why so many people with BPD go into remission (ie remission defined as symptoms decreased to a manageable level, but not ever fully going away) is because of the high suicide rate. By middle age, everyone with BPD has either learned to live with it or are dead or permanently seriously disabled from suicide attempts. Those who have survived, are those who have learnt coping skills to effectively manage it.

Whoa. One of the studies I posted indicated the rate of suicide for BDP was 5% in that study - and they did not consider those people to be "in remission"! It is alarming you think they would. The suicide does not account for the huge percentage of people who recover to the degree they no longer have the diagnosis.

When making statements about a disease that so many people have, and opinions about if it is possible to no longer have the disease, let's try to stick to what data and research indicates, not acedotal stories by co-workers who make broad and extremely dramatic statements that are not based in actual facts.

According to this study, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489848/, people with mood disorders (includng bipolar) and schizophrenia have significantly higher rates of suicide than people with borderline personaility disorder.

Do you know what the irony is? She dismissed my claims of hearing a voice because of her belief that "people with BPD don't have psychotic symptoms" (and because to believe me, meant she thought she'd have to believe my real diagnosis of bipolar) when in her ignorance she was unaware that even those who genuinely have BPD actually do suffer from psychotic symptoms. ie the irony is, she disbelieved a symptoms of my bipolar, which many sufferers of BPD also have, purely because she refused to consider I have bipolar and thought it would disprove my misdiagnosis to believe me.

I don’t follow you here. Are you saying that psychotic symptoms are a part of the diagnostic criteria for BPD? It’s not listed as symptom of BPD in the DSM 4 or 5.

I have met a lot of people with BPD both professionally and personally, and by definition of what BPD is, a person with it is too hyper sensitive to cope in certain fields. I'll reply more to the other post I just read to explain more...

How do you know what so many people have been diagnosed with? Is this a diagnosis you feel they have, or that they are telling you that they have? It is in my experience that people in professional relationships with each other don't go around announcing that they have Borderline Personality Disorder (nor any other mental health condition) to other colleagues on a regular basis.

I don't see anything in the diagnositic criteria of unable "to cope in certain fields." Yet you claim it as a true fact for people with BPD as an aspect of BPD?

You declare that once someone has BPD, they always have BPD... where is the data for your claim?

 

[Butterflywings]

Because they're actually the same diagnosis. Hermans existing proposal of diagnostic symptoms and clusters was Van der Kolks continuing work. Herman stopped a lot of her work, and Van der Kolk picked up turning it towards DESNOS, as CPTSD was failing viability in proposals. Both failed overall though for getting a complex trauma diagnosis recognised, unfortunately...

Read Hermans and Van der Kolks proposed clusters, and they're near identical in overall syptomology. Both are about a part PTSD + BPD + Dissociation approach.

Sorry not meaning to be difficult Anthony but I was asking why you believe they are the same diagnosis. I've spent days now looking up DESNOS and I can't see much overlap in symptomology with CPTSD at all. I've only read some of Herman's Trauma and Recovery (eagerly awaiting the full book's arrival in the mail) but I don't see any part BPD, part PTSD in the CPTSD criteria I've seen proposed. All I've seen in the CPTSD I've looked at is full PTSD with trauma of a complex nature. I don't see BPD in it at all. And in DESNOS, I see very little PTSD at all - it's just mostly BPD symptoms but caused by a trauma instead of genetics.

What symptomology do you see as nearly identical?

 

[Justmehere]

I think what you wrote that I just quoted sums up what I'm trying to say about BPD "relapse, or the recurrence of full-blown symptoms after remission, is rare." Full blown symptoms do not come back after remission, but the underlying less severe symptoms never full go away. I would consider that only partial remission not full remission.

I did not write it. Please re-read. I quoted an article. Again, you confused my quoting researchers, and linked articles, as my own statements.

 

[Justmehere]

Temple Grandin is a good example... I bet she wouldn't change her mind about social expectation just because someone told her "oh that's not socially appropriate".

Actually, she does change her mind on that for exactly that reason, and she writes extensively about why she does.

I think what I said about aspies and changing their mind has been taken out of context.

You don’t seem to ever take responsibility for your own writings or actions. You tell others they are making broad generalizations while making them yourself, again and again. You state very clearly that people with Aspergers can’t change their minds, and then you attack others for saying the same, and then you say they took your words out of context. Could it be possible that your words were not clearly written by you to begin with?