COULD "bullying" be enough to flip the switch for some people? How do we know? People's individual personalities are so different. Their sensitivities, etc are so different, I wonder how accurate "criteria A" is. I'm not saying it's not. Not arguing any particular point at all, other than to say I wonder how accurate it really is and how do we know? Especially "how do we know?"
We don't. No-one does. It's a hard fact to say, but it's a fact: there is no objective metric for measuring the damaging effect of fear, stress, or emotional disturbance.
There is lots of good research, and promising theories, and things that just sound like they make sense - especially to people with PTSD. That last bit is the trap, because we who have the disorder can think we understand it better than a scientist looking at mice. In some ways, we do - but in the objective measure of it, we don't.
I also think it's always good to remember that we on the forum don't necessarily represent a cross-section of the PTSD population. I suspect we represent a portion of it, the portion that tilts towards cases that are more complicated.
Once you get into multiple traumas, you're into an area that the objective research hasn't even touched, as far as I can see. How does trauma affect the traumatized brain? Is it a pile up, or is it irrelevant? For some people, it seems, the answers are different - but that's just speaking anecdotally - there's no objective data.
I keep using the word 'objective' only because it's very significant. So long as a disorder is in the realm of patient-reporting, it places more burden on health care practitioner interpreting, and it gets more prone to error. Any attempt to narrow or focus diagnostic criteria is valuable, because it will ultimately help the doctor-patient collaboration eliminate things that don't apply.
Judith Herman proposed sort of replacing BPD with CPTSD. In some cases, that probably makes sense. But there are a whole lot of people with childhood trauma that exhibit different symptoms and would be better served by DTD.
I agree with the DTD approach, and disagree strongly with replacing BPD.
If we think PTSD is hard to diagnose, in all it's forms - I will say, personality disorders are as hard, or harder. Way over-diagnosed, in my opinion. It's not very common to be at a pathological level of the behaviors that warrant a personality disorder diagnosis. I have a number of experiences with people with BPD, and it is easy to see, once you know how to see it. But each of the criteria operate on a spectrum - and it's the judgement of the clinician, to see how many criteria are manifesting strongly enough to warrant the diagnosis. Yes, it's a disorder that comes from experiencing something like compound trauma - but it has a treatment protocol that has good data backing it up (DBT), and is separate enough from even CPTSD, that they should be kept apart, in my opinion.
The layman's way to understand grouping these things is, if one diagnosis can be seen to cause a different symptom grouping, and each one can be treated separately - sequentially or concurrently - then you have two different diagnoses at play. I probably wouldn't have a problem with blood clots if I hadn't broken my knee. Forming clots post-surgery is a known phenomenon, because of the conditions caused by recuperation. They have overlapping treatments. But one doesn't necessarily lead to the other.
This is just infinitely more challenging with mental health, because we can't take an x-ray.
