Lets Create A Ptsd Diagnosis

[joeylittle]

Like the people who have to watch children being raped for hours on end day in and day out, dealing with catching or prosecuting child porn; crime scene & evidence; arson & disaster / insurance investigators; genocide & war crime investigators; torture & human rights violation footage; etc.

I might be saying that I don't think their diagnosis, if traumatized, should be PTSD. And I'm possibly wrong about that. I just think that PTSD is trying to encapsulate too many things. But there's lots of research I'd have to do, to really back up my opinion on this.

 

[anthony]

I have moved the noise, off-topic, to https://www.myptsd.com/threads/lets-create-a-ptsd-diagnosis-off-topic-discussion.60565/

Please keep this thread on topic to the specific aspect being discussed, as it will be lengthy and otherwise become convoluted.

If you have specific points about criterion A, then please share them, otherwise, keep everything else until the specific aspect for that discussion.

 

[Deleted member 28740]

Couldn't you exclude the need for clauses (1) & (2) altogether by simply starting Criteria A with "Direct exposure...". That would encompass both experiencing and directly witnessing...?

No, different. Rape direct. Drive by shooting and just lucky to not get hit in proximity.

Question also of "delayed" manifestation of PTSD and cumulative traumas. Impact of another trauma breaking the camels back.

Also that same events do not result in PTSD for the general population.

 

[anthony]

Ok, I think the discussion leans towards keeping criterion A. So we work with that.

Like the people who have to watch children being raped for hours on end day in and day out, dealing with catching or prosecuting child porn; crime scene & evidence; arson & disaster / insurance investigators; genocide & war crime investigators; torture & human rights violation footage; etc.

I think the below still adequately covers your points. "Direct Exposure" is equal to someone being exposed to sexual violence, such as rape investigator, prosecutor, anyone who deals with it day in, day out. Not sure an arson / insurance investigator should be covered, unless they're the ones who discover the body, at which point they just met direct exposure to death by doing so. This removes employment types and keeps things linked to direct traumatic events. Maybe a sub-clause about electronic media not being covered unless it is part of your employment and that employment required longevity exposure to such graphic footage.

I just think that PTSD is trying to encapsulate too many things.

Yup.

I think you could then cut your version down to:

A. Direct exposure to actual or immediate threat of death, catastrophic injury, or sexual violence. (Does not apply to exposure to electronic media, television, movies, or pictures, unless the exposure is work related for a period of longevity.)

It says the same thing, adding direct to the beginning. Whether it happened to you, or you witnessed it, the exposure was direct, not third hand. What holes exist in that?

Gene pool lottery

I don't think we should discuss genetics, as there is no evidence to support genetics with PTSD.

Can we also please keep out all the proposed and failed diagnoses. They are not relevant. We have PTSD, we will soon have CPTSD as part of the ICD 11. There is no DESNOS, DTD or other trauma related official diagnosis at this time. Lets work with the facts and stay clear of as much noise as possible, otherwise this gets deep in bullshit and loses focus from the aim -- to create a logical PTSD diagnosis that caters complex trauma adequately.

PTSD diagnosis has plenty of room to cater PTSD and CPTSD, as many of the symptoms are intertwined, and you only need add a further symptom group or two of which x are met, CPTSD is diagnosed instead of PTSD.

Criterion A is the debate right now.

 

[Sideways]

I'm not sure the brackets fit, & I'd probably remove them...(sorry!).

Frequent & chronic exposure to trauma in any form (from work to growing up in a warzone) is a stress response to a 'chronic' stressor, which we (appear to be) deliberately destinguishing from straight-up PTSD, which we're defining as a stress response to 'direct & immediate' trauma.

 

[anthony]

Frequent & chronic exposure to trauma in any form (from work to growing up in a warzone)

Do you have a better example? Growing up in a war zone would expose you to the above and meet the criterion A requirement (direct exposure), so this example does not convey your point well IMO.

Direct exposure is direct exposure, whether as a child or adult. Whilst being exposed to lots of smaller stressors is completely different, and more likely you grow into adulthood with anxiety or such, but that does not meet PTSD currently, so not sure we should be trying to. Unless I am missing something.

 

[Sideways]

Other examples: being housed in a refugee camp as an adult? Living in areas that are post-war where the violence has stopped but the place is still in ruins and you're surrounded by wounded survivors even though you didn't live through the war period yourself...?

 

[Friday]

A. Direct exposure to actual or immediate threat of death, catastrophic injury, or sexual violence. (Does not apply to exposure to electronic media, television, movies, or pictures, unless the exposure is work related for a period of longevity.)

It says the same thing, adding direct to the beginning. Whether it happened to you, or you witnessed it, the exposure was direct, not third hand. What holes exist in that?

Off the cuff, I like this.

Concise. Direct. Unbiased.

Only wording change I would suggest would be "Does not apply to exposure to visual or audio media..." to make room for tech advancements.

Not sure an arson / insurance investigator should be covered, unless they're the ones who discover the body, at which point they just met direct exposure to death by doing so. This removes employment types and keeps things linked to direct traumatic events.

I'm in favor of not listing employment examples at all. Was just thinking out loud.

I do wonder, however, what the stats are for PTSD from purely long term 3rd person exposure through media, at all? Without any incidence whatsoever in the past of direct exposure? I can see it being enough on one hand, but can also see it "just" being the stressor that finally knocked the camel on its ass. Do we have good data on this? Because otherwise I think the first part covers it. Can we nix 3rd hand entirely, or is there validity in keeping it?

ETA... @joeylittle, too... Since it was that same nixing of that 4th requirement I originally questioned, and the more I think on it, the more I wonder.

 

[Deleted member 28740]

A. Direct exposure to actual or immediate threat of death, catastrophic injury, or sexual violence. (Does not apply to exposure to electronic media, television, movies, or pictures, unless the exposure is work related for a period of longevity.)

Term "exposure" relating to electronic media, etc. Not sure what to change that to, viewing of…. Exposure has consequences, i.e. radiation, surgery, physical violence and results there of. Yes a child exposed to violent media… when is it exposure with impact or merely viewed?

 

[anthony]

housed in a refugee camp as an adult? Living in areas that are post-war where the violence has stopped but the place is still in ruins and you're surrounded by wounded survivors even though you didn't live through the war period yourself

Ok, so can you please elaborate on what specifically would cause PTSD under these circumstances?

How would being housed in a refugee camp as an adult, or child, cause PTSD? It's just a community.

How would living in an area post-war create PTSD? Where they there pre and during war? What did they experience post-war that would cause PTSD? Certainly moving to a new town after a war, even in disrepair, would not cause PTSD?

Anyone still surrounded by wounded survivors, would that not meet direct exposure to catastrophic injury? Already encompassed?

 

[anthony]

what the stats are for PTSD from purely long term 3rd person exposure through media, at all?

I did read a study on this... a bit busy at present, but will try and search it down. It was part of the inclusion for the DSM V, as it was happening to people who's day job was literally watching traumatic, real life trauma to process for further action.

Yes a child exposed to violent media… when is it exposure with impact or merely viewed?

Now that is a big hole discovered. +1

If you were a child and the only trauma you endured was an adult forcing you to watch real-life traumatic content, then you would not be covered due to the current wording that electronic media is not sufficient unless work related.

A distinguishment need be made between real life trauma and fictional violence created for movies and such.

 

[Sideways]

I was just thinking that the brackets include work-related exposure if that exposure is for a prolonged period. In my mind, that seems to creep into the realm of chronic trauma, rather than 'direct and immediate' trauma..?