Lets Create A Ptsd Diagnosis

[joeylittle]

I'm guessing they don't use anhedonia specifically because it's such a keystone symptom of depression. Just a guess, but makes me think the DSM writers are trying to avoid some kind of overlap.

D7 is really anhedonia: inability to feel pleasure in normally pleasurable activities - Maybe should simply be called this instead of confusing between mood state and emotional state? Maybe even just use the definition of anhedonia to keep it simple as is, yet correctly reflect with more accuracy?

The definition of anhedonia I can find that is specific to the DSM is "Lack of enjoyment from, engagement in, or energy for life‟s experiences; deficits in the capacity to feel pleasure or take interest in things." It's a little broader than only inability to experience positive emotion - you also lack the capacity to be interested in activities that would generate that.

So, with anhedonia, you would struggle to motivate yourself to sex, let alone be able to enjoy it. I don't think it would serve us for PTSD, it's much more specific to MDD, some personality disorders, schizophrenia.

D4 is a mood state and D7 a cognitive one.

True - I can see that now. And this bit really does separate them:

D4 - A persistent negative mood state (fear, horror, anger, guilt, shame) either began or worsened after exposure to the event.

, meaning that you need to rule it out if that was the mental state prior to the trauma event.

It's only nagging at me that they are so very close. But I think that bit needs to be added back into the second half of D4, in order to make it specific to PTSD.

 

[anthony]

But I think that bit needs to be added back into the second half of D4, in order to make it specific to PTSD.

Well... the subtext to the entire diagnosis must already be viewed and incorporated within diagnosing. This applies to all diagnosing. This is why its so dangerous for people to read a diagnostic checklist online, as they're not really reading the entire scope of the diagnostic provisions laid out in the full text that must accompany the criterion themselves. They aren't standalone already... its just people think a diagnosis stands by itself.

It is why I added a good proportion of the accompanying provisions into the PTSD article which contains the current diagnostic criterion, so people understand the full scope and context and not just focus on the criterion singularly. People are people though and choose what they focus on, but the info is provided here already. Not sure you can provide all those aspects into the diagnosis itself, as it makes it substantially long.

If viewed this way, then all criterion can have quite a lot added to them to be more accurate.

 

[oasis2003]

Yes to one to 7 and yes somatisation needs to be added with painful experiencing. Either pain then thought and body sensations, or thought then pain and body sensations . It depends whether pain has been suppressed or not ?

 

[anthony]

Ok... so really, are there any real changes needed for D cluster? Or is it good to lock in as is?

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by three (or more) of the following:

1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “no one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

 

[oasis2003]

Does dissociation , derealisation and depersonalisation , come in another part or is this all there is for dissociation? If this is all then I think more should be put in about the different types of dissociation.

 

[anthony]

Dissociative reactions is already in cluster B. We're talking cluster D at present, please ensure you have read the opening posts and keep this on topic. All off topic for what is being discussed can be discussed in the off-topic side thread, stuck next to this one.

Once done, the entire thing is then up for further tweaking as appropriate.

 

[oasis2003]

Ok well from reading previous cluster d then this seems OK in my opinion then

 

[anthony]

Ok, cluster D locked in for now. Cluster E it is.

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by three (or more) of the following:

1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

Ok, first basic change the symptom quantity.

Somatisation needs to be in context and added.

 

[joeylittle]

I always wish that Hypervigilance was defined by characteristics.

3. Hypervigilance, expressed as paranoidal thinking, excessive personal protection (sleeping with a weapon, sitting with all exits in view), enhanced adrenaline response, avoidance of open space, etc.

And Problems with concentration.

5. Problems with concentration (e.g. difficulty in maintaining focus, completing simple tasks, or short-term recall)

I really don't know if this is necessary. I have found that 'hypervigilance', much like 'anhedonia', is a nuanced term that is easily misunderstood. There's a certain amount of vigilance that is appropriate to daily life, and so, it seems that articulating how hyper vigilance is expressed would be useful. Could be overkill...

Problems with concentration is a psych diagnosis phrase that I personally did not understand until it was explained to me, and I'm a language freak. I don't even know if what I wrote explains it perfectly well.

I'm curious to hear other peoples' thoughts on those two.

 

[anthony]

I will look in dsm for additional text to see if we can make it easier than it is.

 

[anthony]

3. Hypervigilance, expressed as paranoidal thinking, excessive personal protection (sleeping with a weapon, sitting with all exits in view), enhanced adrenaline response, avoidance of open space, etc.

DSM additional states: PTSD is often characterised by a heightened sensitivity to potential threats, including those that are related to the traumatic experience (e.g. following a motor vehicle accident, being especially sensitive to the threat potentially caused by cars or trucks) and those not related to the traumatic event (e.g. being fearful of suffering a heart attack).

5. Problems with concentration (e.g. difficulty in maintaining focus, completing simple tasks, or short-term recall)

DSM additional states: Concentration difficulties, including difficulty remembering daily events (e.g. forgetting one's telephone number) or attending to focused tasks (e.g. following a conversation for a sustained period of time), are commonly reported.

I think if you expand one with examples, then all should be covered adequately for ease, however, is it warranted for diagnostic purpose when only a trained therapist is actually using it for diagnosis?

 

[joeylittle]

is it warranted for diagnostic purpose when only a trained therapist is actually using it for diagnosis?

I think that the DSM probably includes the details specifically because there is not a 'clean' definition of some of these phrases, they are left a little open so that they can be slightly shifted to accommodate the purpose. OR, they include the definition to make sure there is unity in application.

Hyper-vigilance is one where, expressing detail I think could be helpful.

3. Hypervigilance, expressed as a sensitivity to threat, including those that are related to the traumatic experience (e.g. following a motor vehicle accident, being especially sensitive to the threat potentially caused by cars or trucks) and those not related to the traumatic event (e.g. being fearful of suffering a heart attack).

That's wordy - but it's new information - that the hyper vigilance is not limited to things directly associated with the trauma event. Is it important to specify that?