What Are The Main Differences Between Ptsd And Complex Ptsd?

[Lucycat]

Why do the proposed diagnostic criteria refer to 'alterations'? When we speak of childhood trauma, there is no before and after, and 'alterations' are therefore not applicable. Could someone help me out here?

I understood this to mean alterations (or deviations but that has its own problems) from the perceived norm.

 

[Deleted member 1860]

I think "alterations" is in the same realm as "alters" which in the world of complex trauma means other parts of your personality, although it doesn't necessarily imply a complete splitting.

 

[Pencil]

No, it can't be the perceived norm, and neither does it refer to alters. Let's look at criterion 6, for example:

1. Alterations in Systems of Meaning (A or B required):
   • Despair and Hopelessness
   • Loss of Previously Sustaining Beliefs

In the event of PTSD it make sense that a person who went through an ordeal might question the existence of God, for instance. I have always struggled with the Christian concept of God as God the Father, and as a child I feared God, who was made in the image of my father (as this is what kids do) more than my father. The point I'm trying to make (after waffling, as usual) is that for me there is no 'change' from one thing to another. This is why C-PTSD criteria can't possibly fit prolonged childhood abuse as there is simply no ... before and after, only 'after'. There is often no loss of 'previously sustaining beliefs', only a lifelong attempt at developing / amending sustaining beliefs.

For this reason the criteria - with the focus on before and after - seem to me to fit PTSD rather than complex trauma resulting from childhood trauma.

 

[Lucycat]

Is it possible that a previously sustaining belief - even at a pre-verbal level - is that a parent/care-giver would nurture, protect and provide for a child and that belief is lost as the reality takes over - again even at a pre-verbal level.
I don't know I just wonder if belief has to belong to religion?

 

[scout86]

I looked up DSM-V, then I tried to find something that appeared to represent a generally accepted criteria for c-PTSD (which wasn't as easy as I thought it would be!)

The first thing I have to say is that, they were very obviously written by very different people. With some things, I was left wondering how much was "real difference" and how much was difference in word choices and emphasis. I honestly don't know. The 2 lists are written so differently that they are hard to compare.

@Lucycat, I think you're on to something.

@Pencil, what you just mentioned is one of the places where I wondered how much REAL difference the is. Talking about "before" and "after" with little kids is tricky. There probably WAS a "before" you just don't remember it and it may have been as short as the time you were in the hospital. But, how many "normal" children live with "hopelessness and despair"? If a kid is experiencing that, I'd be willing to bet they were almost never BORN that way. Similarly, as a species we are kind of hard wired to trust our early caregivers. We have to LEARN not to. I agree, though, there's a way more obvious "before" with some kind of "adult onset" PTSD.

 

[shimmerz]

There probably WAS a "before" you just don't remember it and it may have been as short as the time you were in the hospital. But, how many "normal" children live with "hopelessness and despair"? If a kid is experiencing that, I'd be willing to bet they were almost never BORN that way. Similarly, as a species we are kind of hard wired to trust our early caregivers. We have to LEARN not to. I agree, though, there's a way more obvious "before" with some kind of "adult onset" PTSD.

I think there is great value in this statement @scout86 . There is a point in time in my opinion where we are hardwired to expect nurturing (or we wouldn't cry for it or fuss) as well as safety in care. It is in blowing away the 'knowing' that we learned with neglectful or unsafe parents that we can get to the blank slate we were and allowing those expectations to integrate that helps to make us whole. It is a whole heck of a lot of work as we must first dismantle, then realize a concept (safety and compassion are our right and we owe it to ourselves to realize what that concept means to us) and then rebuilding our support system so that we are surrounded by people who help us to nurture our newly found concept.

Just my two cents worth. ;)

 

[Justmehere]

In regards to the difference between PTSD and "complex PTSD" -

Is it possible to develop complex PTSD symptoms in response to single event trauma?

I looked up DSM-V, then I tried to find something that appeared to represent a generally accepted criteria for c-PTSD (which wasn't as easy as I thought it would be!)

I have found several descriptions of "complex PTSD." I also briefly (for 3 months) saw someone who co-wrote research articles and books with Judith Herman, one of the people to first coin the term "complex PTSD." They explained to me in a totally different understanding of "complex PTSD" way than what I think is more often use as the proposed criteria that folks talk about here.

I think what is hard for me, is when people say they have "complex PTSD," I'm not sure what that means or how it looks different than PTSD.

I understand generally these things and some of the many ways they can manifest: PTSD, trauma related BPD, attachment disorders, dissociation, DID (dissociative identity disorder), etc... I understand general these terms too: complex trauma i, relational trauma, developmental trauma, combat trauma, etc.

But when someone says "I have complex PTSD" I'm not sure what that is or what it looks like apart from PTSD symptoms. Some say it is PTSD plus BPD or dissociative features, some say it's PTSD plus attachment problems, some say it is based on the amount of trauma, not severity of symptoms per say....

Honestly, when someone says I have "complex PTSD," I feel really stupid because I'm not sure what that means beyond having PTSD symptoms. Does anyone experience this? ugh. I feel stupid writing this now, because I feel like it maybe should be obvious. I'm wondering how others see it. If someone tells me they have DID, I can think oh, they generally struggle with xyz. But when they say I have "complex PTSD" - what I think is oh, they have PTSD and.... um.... I don't know. Maybe I'm just dense (highly likely).

This is not a criticism against those who use complex PTSD. It is against myself! It's something I'm trying to understand better. I have been told myself I have complex PTSD. I push back against believing I have PTSD at all, so I haven't been too concerned about the "complex PTSD." I know that for me, my providers also tell me I have PTSD with dissociative features and a disorganized attachment pattern. I also used have OCD, which was PTSD related, but I no longer have due to getting help for the underlying PTSD. I understand all of those, but when they start talking about complex PTSD, I get lost. I wonder if this is an internal defense mechanism of mine since I have such a hard time accepting there was any trauma to begin with, let alone mental health problems that developed as a result of trauma. I hate having to face I was a victim... but I digress.

 

[Pencil]

Some say it is PTSD plus BPD or dissociative features, some say it's PTSD plus attachment problems, some say it is

If I'm not mistaken, that is the whole point. CPTSD is PTSD with one or more other things. And that is why I can see that one diagnosis, i.e. CPTSD, can't fit all with 'complex trauma' as we're really talking about an umbrella term for different combinations of different things together with PTSD.

We have to remember that PTSD is the only disorder that is predicated on the presence of trauma as a cause, - in other words, the only diagnosis that is made not on the symptoms, but on what caused the symptoms. It is for this reason that 'complex trauma' can't get away from 'trauma' and therefore it can't get away from PTSD - which is what @anthony advocates. This is how I understand his stance. I could be wrong, of course.

 

[Meadowsweet]

@Justmehere, I relate a lot to what you say here. This is why CPTSD doesn't work. It's perhaps why too much labelling doesn't work either. Because we all have a whole complex web of pieces that are put together is different ways.

There is a limit to what a diagnosis can tell a therapist or the person with the disordered mind. After that, it's down to looking at what triggers those symptoms and what to do about it.

 

[Pencil]

I find the labels enormously helpful. It was only when I found out about attachment disorders and OSDD that I started understanding myself - and realized what therapy would work and what would be completely wrong for me. Without the labels I was completely lost.

 

[anthony]

http://www.ejpt.net/index.php/ejpt/article/view/20706/html

It will be interesting to see whether the ICD goes for this, based purely upon the opening statement for both diagnoses criterion, they're asking that PTSD be changed into a six symptom diagnosis, then the CPTSD one be expanded with symptoms regardless of trauma reminders.

The PTSD diagnosis is proposed to consist of a reduced set of six symptoms making up three core elements, each of which is required for the diagnosis: re-experiencing of the traumatic event(s) in the present accompanied by emotions of fear or horror; avoidance of traumatic reminders; and a sense of current threat that is manifested by excessive hypervigilance or an enhanced startle reaction. The syndrome has fear or horror at its heart with a focus on the re-experiencing of the trauma memory and consequent avoidance and hypervigilance. This formulation conceptualizes PTSD essentially as a fear condition and emphasizes symptoms that distinguish it from other psychiatric disorders, in line with recommendations by Brewin, Lanius, Novac, Schnyder, and Galea (2009) and Spitzer, First, and Wakefield (2007).

Proposed ICD-11 complex PTSD is a disorder that requires PTSD symptoms as defined above but also includes three additional features that reflect the impact that trauma can have on systems of self-organization, specifically problems in affective, self-concept, and relational domains. Unlike the PTSD symptoms in which reactions of fear or horror are tied to trauma-related stimuli, these three latter types of disturbances are pervasive and occur across various contexts and relationships regardless of proximity to traumatic reminders.

Talk about chop and change for recognition... any recognition, it seems the cost of diagnostic acceptance is of no concern.

 

[tacit]

Ok..so here's my crack at it..& please forgive my laymen terms ;)

The explanation for these symptoms is the victim’s failure to develop or maintain adequate “self-functions.” These are basic ingredients required by all individuals to feel emotionally whole and to positively engage the world.

That deprived or traumatized children have been robbed of the “good self-objects” required to provide a “safe holding environment” and required later for “self-soothing.”

In fact, experts had long expressed their concern of limiting the construct of trauma to “PTSD.” The most notable downside of the narrow PTSD paradigm was the exclusion of a diagnostic label for trauma victims presenting with some of these other important trauma generated symptoms.

This new diagnostic entity would provide a legitimate forum for victims of continuous trauma who present with a spectrum of functional impairments that appear quite distinct from PTSD.

As a diagnostic syndrome, complex trauma highlighted problems not captured by PTSD.
These symptom domains appeared most pertinent for victims of child abuse, rape, incest, battered spouses, and victims of political terror such as civil war or genocide.

The value of the “complex trauma” construct in the DSM Manual for the victims of chronic interpersonal trauma should provide a diagnostic umbrella for victims whose symptoms were previously dispersed throughout different DSM categories.

Victims with complex trauma have symptoms that govern essential and enduring personality- or “self-functions.” They have deficits in autonomy, empowerment, and self-agency, which belong more to Axis II (the domain which addresses the “personality behind the presenting symptoms”).

Since this type of trauma victim shows impairment in core self-functioning, “complex trauma” would provide an appropriate diagnosis more far-reaching than PTSD in its complexity and implications for treatment.

The DSM-IV Field Trial attempted to create the term “DESNOS” for those patients whom they believed suffered additional symptoms of PTSD.

In reviewing the PTSD Field Trial, Ford found that a “substantial proportion of complex trauma survivors do not meet lifetime criteria for PTSD.”

Ford further noted that while patients with PTSD suffer from a flood of terrifying thoughts, emotions and impulses (in addition to reliving the trauma and having out of control experiences), the victims of prolonged interpersonal abuse resulted in disturbance of core object-relations, dysregulation of affect, and a lack of self-cohesion (which falls under the category of “dissociation”).

Many experts believe that complex trauma and PTSD are separate entities with some overlap.

The problem with the DSM-IV committee’s construct of DESNOS was to bundle PTSD symptoms together with Complex Trauma.

This would exclude victims who suffered from Complex Trauma (only) but without PTSD.

Complex Trauma victims will continue to find themselves with a diverse range miscellaneous diagnoses until this entity is fully recognized.