Lets Create A Ptsd Diagnosis

[Sideways]

Maybe we need to come at it the other way and try and define the symptoms first?

That may help clarify what we want to include or exclude in the definition of trauma, or, a satisfactory symptoms list may exclude the need to define trauma at all. The symptoms may speak for themselves, without the need for an extraneous definition of trauma.

But if the symptoms need to be generalised because we can't pinpoint them, a preliminary definition of trauma is more relevant.

 

[anthony]

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.)

I like the criterion so far, just not the media aspect.

(Does not apply to exposure to electronic media, television, movies, or pictures, unless the exposure is work related for a period of longevity.)

Maybe that is better written as inclusive also, as that is exclusive versus the criterion being inclusive. Maybe that is the issue?

So: (Electronic media, television, movies, or picture, exposure must be duress or work related for a period of longevity.)

Defined law of 'duress': constraint illegally exercised to force someone to perform an act.

 

[anthony]

Maybe we need to come at it the other way and try and define the symptoms first?

Symptoms and trauma are very different avenues. I don't believe symptoms will lead closer to defining trauma. If you cannot define trauma adequately, in essence, you cannot derive the symptoms experienced for that trauma definition that must be first met.

 

[Sideways]

Direct exposure to actual or immediate threat of death, catastrophic injury, or sexual violence; or
Frequent and chronic exposure to death, catastrophic injury or sexual violence, where that exposure is for work purposes.
(Does not apply to exposure to forms of electronic media, such as television, movies, or pictures, unless that exposure is under duress.)

That eliminates the possible confusion that the duress exemption may, like work exposure, need to be for prolonged periods.

 

[Sideways]

Sorry - the brackets about media should be at the end of the first clause, so the exclusion doesn't apply to the work-related clause.

 

[digger]

ICD 10 PTSD

F43.1 Post-traumatic stress disorder
Diagnostic Criteria

A. Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.

So people diagnosed in parts of the world where this criteria is used instead don't have the restriction of trauma having had to include actual or threatened death (unless that's what catastrophic refers to in this context?) It would be interesting to know how the decision was reached to exclude that. Is it that the DSM has narrowed the focus over time to include less or that the ICD has broadened it to be able to include more?

 

[Chava]

This is a sufferers view for what the PTSD diagnosis should be. I would suggest it is done in such a way that it covers both trauma and complex trauma in a single diagnosis.

Since sub-types came up. One heading, sub-types:

I'd probably call them all disorders of extreme stress (NOT an anxiety disorder), as a heading, and break it down into PTSD, CPTSD, DTD (specify early, developmental trauma), and DESNOS (like traumatized responses from cops after witnessing too much violence) ??? . Many people would find overlap, but that happens with a whole bunch of mental illnesses anyway.

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.

CPTSD was a failed diagnosis and people here were knocking it a few years ago. They all seem to fail the first time around. So, nothing's over yet. Besides, it's not very clear here if we are working with facts or opinions anyway, or just certain opinions, since we are making up our own ideas for the diagnostic criteria and language. ?

Anyway, a single diagnosis would then need to encompass all the features of early trauma, which make it one long messy set of criteria (this more global set from early or complex trauma is why we have this international debate happening in the first place), but anyway...

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.

So 2 diagnosis? Yes, CPTSD could cover developmental or chronic childhood trauma, but might also present differently from adult complex trauma. Somewhere back I said PTSD as it is currently described, including criterion A (really important) is fine, though best diagnosed by a specialist who well understands trauma. The only difference I'd see with differentiating for childhood trauma is the Criterion A, which would still include the same level of threat or exposure to life threat. That could also just be left the same and a trained trauma therapist would understand that total neglect IS life threat to a child (not an adult)...like leaving a baby alone in a crib for most of 1.5 years, barely sustaining life. Sadly, it happens. Under current PTSD, diagnosed by a trauma therapist, it would still fit (but also likely attachment disorder...alright, I'll admit that is a sideshoot, but not the currently still studied options for CPTSD and DTD...these are still in the workings).

Criterion A is the debate right now.

Too many rules for participating in this thread to follow. Threatening thread-banning for getting off topic? How often do people inject off-shoots into threads, especially long ones? So, I'm done. But the developmental trauma theorists and research isn't going away, which I believe is fantastic.

 

[joeylittle]

don't have the restriction of trauma having had to include actual or threatened death (unless that's what catastrophic refers to in this context?)

I believe it's what catastrophic is meant to refer to. The looseness of the language here simply gives the diagnostician more room to maneuver. Narrowing the terms in DSM to only include death, catastrophic injury, or sexual violence is a way to exclude something that could be considered 'serious' injury - not life-threatening or life-changing.

But human pain is a slippery thing, if it is a thing at all: how it is registered and measured depends on philosophical and sociomoral considerations that evolve over time and cannot simply be reduced to a technical matter.
Mental health diagnosis, period, is philosophical, not evidence based.

Yes, it is. It's why studying the brain is so significant, for everything we call mental health. I do think we will see quantitative scientific diagnosis of mental health issues in our lifetime - I'm not sure if they will get all of them, but I really believe they will have made real, practical progress over the next 20 years. Here's hoping, anyway. But until then, what we are left looking for is language that tries to capture an experience common enough to yield similar results.

If we didn't have x-ray capability, and had to describe what sort of situation might cause a broken joint - knowing that there would be no way of really proving it was broken - that's the kind of description that PTSD is reaching for. Catastrophic, blunt-force, trauma, bent beyond normal parameters, etc.

Post-traumatic stress disorder legitimised their “victimhood,” gave them moral exculpation, and guaranteed them a disability pension because the diagnosis could be attested to by a doctor; this was a potent combination.

In the US, this is very important to remember. Glad you looked it up, @anthony. And circling back around to @digger's comparison with the ICD - in the US, all these diagnoses ultimately link to medical care, which is for-profit. So the US has reasons for wanting a diagnosis to be as exclusionary/narrow as possible. I don't even know if those reasons are nefarious, on the committee level - it's just deeply entrenched in our system. If it's too easy to be diagnosed, then it's too easy to require health care, and too many disability claims can bankrupt the social security system. Ish. That's a very loose description, but I'm sure the point is clear.

How invested are we in being exclusionary?

I'm throwing this on the table again. I still think direct exposure needs to be specified, as below. I've adjusted the media clause to be more open ended.

A. Direct exposure (via experiencing or witnessing) to actual or immediate threat of: death, catastrophic injury, and/or sexual violence. (Does not apply to exposure via electronic media, television, movies, pictures, or text, unless the exposure is of significant frequency and duration.)

 

[Deleted member 28740]

Catastrophic Injury Law & Legal Definition - USLegal, Inc
Catastrophic injury means "consequences of an injury that permanently prevent an individual from performing any gainful work."(42 USCS § 3796b)

Get into the real language being used. Exposure is another, and sexual 'violence'.

words to, by, from, or - use is messy, tangled. JMHO

 

[joeylittle]

(42 USCS § 3796b)

This is from the Public Safety Officers' Benefits Improvements Act, and the language you are using is from the 1976 version*; it was amended in the 2012 version**. That's all I'm able to follow, I'm not a lawyer. There is no single definition of catastrophic injury in US (or international) legal terms. I'd propose that this definition is more useful/practical: codification in sports injury, which you can read here: http://nccsir.unc.edu/definition-of-injury/

I agree with you that language matters: however, many descriptions don't mean the same thing across disciplines: law, science, medicine - they all define things differently. This then allows for interpretation, which is important, as no two situations are ever exactly alike.


Link Removed
** https://www.govtrack.us/congress/bills/112/hr4018/text

 

[Sideways]

Okay, so I am a lawyer. And here in Australia, 'catastrophic injury' to my knowledge, has not been given a literal definition at common law, which allows for some flexibility in interpretation.

But 'catastrophic injury' speaks directly to insurers. I can't speak for the medical profession, but certainly with the larger insurers, 'catastrophic injury' claims are distinguished from ordinary 'personal injuries' and usually handled separately.

The point is just that, from a legal perspective, when you say 'catastrophic injury', even without a formal definition, it is recognised as being in a 'different class' (for want of a better expression) to other thpes of injuries.

Does that help at all?

Re 'duress' - I'm twitchy about this, because there's loads of common law about what qualifies as 'duress', and I think using that term may be inviting lawyers to come along and say, "you've defined that injury wrong because that was/wasn't duress". Where there are potential legal issues involved, my experience is the medical profession prefer to diagnose according to medical terminology...just my experience.

 

[anthony]

A. Direct exposure (via experiencing or witnessing) to actual or immediate threat of: death, catastrophic injury, and/or sexual violence. (Does not apply to exposure via electronic media, television, movies, pictures, or text, unless the exposure is of significant frequency and duration.)

Ok, question. Should the electronic media be exclusionary, when the criterion A is otherwise inclusionary?

Re 'duress' - I'm twitchy about this, because there's loads of common law about what qualifies as 'duress', and I think using that term may be inviting lawyers to come along and say, "you've defined that injury wrong because that was/wasn't duress".

Fair point... you're the solicitor, not me, and that sounds pretty reasonable.

(Does not apply to exposure via electronic media, television, movies, pictures, or text, unless the exposure is of significant frequency and duration.)

The problem that I have with this... is that any kid growing up playing violent video games, now meets significant frequency and duration for electronic exposure. Is this something you want within PTSD in the future, compared with rape, torture, childhood abuse, sexual violence, POW's, so forth?