Ptsd : Dsm-v Vs Icd-10

[Friday]

An ancillary question came up on another thread...Rather than derail that thread... Could @anthony or anyone super caught up on diagnostic criteria clarify?

Differences between the DSM-V & ICD-10 in general & C-PTSD in particular?

I know Complex-PTSD isn't a Dx in the DSMV, and why that decision was made; but while I have http://www.who.int/classifications/icd/en/GRNBOOK.pdf , it's also 263 pages long and I'm on mobile. I just don't hate myself enough today to attempt that. Polysyllabic highly technical jargon just doesn't belong in such an itty bitty living space. The addition of a magnifying glass over pixels? Ugh. Nope. Can't do it! Hilarious, perhaps, but imprudent. My eyes would bleed.

Thank you any & all.

 

[anthony]

What are you looking for specifically? Is cPTSD a diagnosis in the ICD 10? The answer is, no.

The ICD uses Enduring personality change after catastrophic experience. The DSM IV used PTSD + comorbid personality / dissociative disorder.

Now the DSM V uses PTSD with its applicable sub-type, the ICD 11, at present, points cPTSD to Enduring personality change after catastrophic experience, but does recognise the name in the new book.

I believe they have developed criterion specifically for it / adapted criterion from enduring personality, unsure which.

The end result I believe, is that once the ICD 11 goes live, you will have an official name for diagnostic use under the ICD 11, even if the diagnosis is still Enduring personality change after catastrophic experience.

 

[Friday]

Yes, thanks! Sorry to be all rambly in a pretty straight forward Q.

Just to make sure I'm understanding clearly:
Dx alone, or Dx + Enduring Personality Change @ present
1:2 possible diagnosis likely @ 2017

***

I think I need to break down and go get copies of the 10 & 11 rough-draft. DSM makes sense to me, not perfect but sense, but Enduring Personality Change just seems muddy. As if it either requires a baseline to diverge from, or (scarier) is blanketing Personality Disorders resulting from serious & prolonged neglect & abuse under the PTSD flag. I can't imagine that's the intent. (Unless it is, and they're moving towards causality? Trauma resultant personality disorders v. endogenous or no known etiology personality disorders?)

ETA. Gah. I'm sorry. There's no need for me to try & understand subjective & sometimes conflicting taxonomy. I'd just delete the me-thinking-out-loud, except deleted content is even more lame than 'ignore my waffling'.

 

[anthony]

Both are flawed, to some degree, IMHO. The DSM lacks substance to truly reflect complex trauma, and the ICD lumps it into a personality disorder only, leaving no room for affect due to trauma, without being the personality core attribute.

One day doctors might start to listen to sufferers, cut all the crap they go on about, give us a simplified solution -- a trauma focused grading (cause and effect). It would be much simpler at all stages... allows a person to be reviewed as better or worse, gives a definitive guide to level of suffering vs labelling alone.

 

[Friday]

-- a trauma focused grading (cause and effect). It would be much simpler at all stages...

Every once in awhile I'm reminded of how much of a baby science this all is. That we don't already have that in place? Argh. It would be a clear concise tool that would actually be useful.

 

[Friday]

... Any chance with all the data to mine from this site alone, much less academia at large, you might have written one up???

 

[anthony]

Nope.

 

[Eleanor]

FWIW - I'm kind of hopeful that as early childhood development thinking gets more disseminated that the powers that be will realize that things effect children DIFFERENTLY - so developmental trauma must be treated differently than adult trauma. I am also slightly hopeful that with more (and optimistically ) better neuroscience imaging studies undergirded by a robust understanding of both basic emotional response systems and memory that we will get a MUCH better taxonomy of the underlying functional mechanisms. Just as "cancer" (undifferentiated sixty years ago) is actually upon closer and more rigorous examination actually several different things that we counted as the same because they look the same at the macro level - once we get the mechanisms there are several quite different things going on and consequently get a lot better at dealing with them.

 

[anthony]

realize that things effect children DIFFERENTLY - so developmental trauma must be treated differently than adult trauma

Whilst I agree, I also disagree. I agree that developmental trauma must be treated differently. I disagree that things effect children differently, which I assume you're comparing with adulthood. Adult trauma can have the exact same effect that trauma has upon children, hence POW's are an example of how the outcome becomes the same, whether childhood or adulthood trauma, and you can even add combat trauma where multiple tours are involved over years. The trauma impacts the individual at the personality level.

It has always been hypothesised that the personality is fixed come early adulthood, yet research in this area is finding a lot of ambiguity in this theory, such as comparing the outcome on individuals, whether adult or childhood trauma based, being the equal in impact of the psyche and personality. This research has led to the APA dropping the Axis categorisation system, as a result.

Whilst I agree that developmental trauma can be severe, there are also plenty of cases where the equal trauma in childhood has produced non-severe adulthood outcomes. Adulthood trauma has created the same outcomes.

I do concur that as a majority ruleset, childhood trauma is most likely for the severest outcome from severest trauma level, and adulthood flips that to a minority, i.e. needing POW level trauma for the same impact in adulthood.

I think this is the exact issue, in that the scale needs to stop looking at the age and trauma type, but at the trauma level and impact on the individual.

It's like the criterion A debate. Some are fore, some are against. Me personally... I don't care. I simply acknowledge how something is now, not how I would like it to be. When it is different, then I adapt to that. As a result, people who have been cheated on, for example, do not fit PTSD criterion as a result, even though some therapists diagnose them as such. The issue is that when someone says that, purely for example sakes, is that do they actually have a compounding level of smaller trauma throughout their life that this one act of a spouse cheating has been the icing on the cake, so to speak?

Compounding trauma is the current debate for complex PTSD, without a type of trauma specifically, but instead a lifetime / long term duration of smaller traumatic moments and instances, compounding over years, decades, to one event where the psyche just snaps. Right now, again, I stick with the current doctrine how it is, being for PTSD you need to meet the criterion. Yet with a sliding scale, we remove the trauma type and instead each person is looked at uniquely for their life history, level of trauma and then the impact on that individual at the time they snap.

I do believe this will be the future direction, based on current reading, where psychological trauma diagnosis will end-up.

 

[Eleanor]

When I say that things effect children differently I actually mean some pretty specific things. Like: withdrawal of affection IS life threatening for infants. There are cognitive effects in childhood that are not the same as in adults in part because of differences in linguistic and cognitive development - so children process their experience differently. If the hypothesis is true that we all begin with multiple consciousnesses, each associated with a specific emotional response system, and that unifying/integrating those consciousnesses into one single consciousness is a task of development - not a foregone conclusions. Additionally calibrating each of those systems to an environment is also a task of development. Children are hard wired to mirror the emotional responses of their caretakers, and so very easily internalize the emotional responses of others. Adults do this too, but to a much lesser extent because they are not as plastic as very young children, and they mostly are not in as intense contact. Also, memory can serve a mitigating function in adulthood that is simply not possible in childhood. For kids "why you see is what there is" in a very comprehensive way.

Making the situation even more complex is the impact of neglect, physical and emotional, and the role of caretakers who are emotionally poorly regulated themselves. In children neglect and abuse often go hand in glove - and the dynamic set up may well have ... more pervasive impact that trauma later on. At the same time, maybe what predisposes people to get PTSD later in life just IS lacking the calibration/integration from early training that gives one the ability to process traumatic experience and so not get stuck in them. Neglect, neglect plus trauma, and just trauma, chronic trauma, individual trauma.... all overlaid on different temperamental dispositions.... It is a pretty complicated environment to sort out how to 'cut nature at its joints.'

I agree that the symptomology is ... widely divergent and clumps in different ways... and I'm hoping that a better understanding of the emotional and memory systems in particular will help sort it all out. There is some reason to believe (apparently) that children with "attuned and engaged" caretakers are more resilient to trauma by a large stretch.

I think it is a really interesting question about whether personality integration can be dis-integrated by long term trauma or whether there are aspects to it that we have not noticed/taken account of. For instance - might depression and aggression be more in those whose chronic traumatic experiences are later in life? Does time from the trauma have an effect different depending on the stage of development the trauma occurred? Is memory effected?

Clearly some adults are affected differently than others by trauma - what accounts for that? Weakness in the "integration" to begin with? Over-active FEAR or PANIC systems? Gut flora? Sleep deprivation? Lack of context for creating meaning to contain the experience? These are all pretty good guesses. Certainly they each suggest lines of investigation.

There are a lot more questions than answers from where I sit. I like talking about this stuff because .... well because I think it's going to get sorted out in the next thirty years or so.

In the meantime, I am with you - in a practical vein we need to just treat people where they are. While it might be helpful to have a coherent story about cases like this one

The issue is that when someone says that, purely for example sakes, is that do they actually have a compounding level of smaller trauma throughout their life that this one act of a spouse cheating has been the icing on the cake, so to speak?

Where we can figure out that the person's PANIC system never integrated with the others due to neglect, and that the person had multiple abandonment/betrayal traumas as a child (none of which fit criterion A) and so this "virtual re-enactment" as an adult has effectively triggered that earlier state and thrown them into whatever storm of symptoms.... and that might help refine a course of treatment.... It only makes sense to "refine" treatments when we have a really solid set of treatments to begin with. Stuff that is really effective when it is effective - even if it is not effective for everyone.

 

[void]

@anthony
Thank you for teaching us.