All the C-words getting stuck in front of PTSD......

[Weemie]

Well, according to the DSM V, the only version of PTSD that exists is just PTSD. Personally, I think that's all that is really required for diagnostic purposes, with modifiers like complex or combat used for treatment purposes. The DSM is not a treatment manual, it is a diagnostic manual, ergo adding a shit ton of modifiers to the diagnostic handbook is going to wind up with a lot more people misdiagnosed (either with "CPTSD" when criterion A doesn't exist, or CPTSD in place of a more appropriate diagnosis like BPD), and a lot less clinicians who know how to correctly diagnose or even recognize PTSD for what it is.

In this way, a brain is not the same as a piece of machinery, because the diagnostic process for mental illness is not the same as the diagnostic process for fixing a radio. In order to diagnose what is wrong with a radio, you have to open it up and look. With psychiatric disease, this is not possible, so we instead diagnose based on statistical analysis (the "statistical" portion of the DSM) and on clinical presentation (the more people have the same constellation of symptoms, the more likely this is a legitimate issue).

That being said, the various modifiers that exist for PTSD, definitely can have an impact on how responsive to treatment you are and indeed what kind of treatment will be most effective for you. You can also have PTSD that mimics a modifier without actually having endured that specific experience. I don't have combat PTSD because I was never in the military, but I benefit from every treatment targeted toward combat veterans. If we wanted to have "combat PTSD" added to the DSM, then a person like me might actually fail to qualify for the types of treatments that improve my quality of life, even though there is no good reason why I shouldn't have access.

 

[KayW]

I don't have any NHS involvement, mainly because it's my main trauma trigger, but also because like you the waits are so long, for very limited service, it seemed totally pointless.

Unfortunately, I've never been in the financial position to pay for a diagnosis, so I can't say it's totally pointless. I waited, was diagnosed, then waited again for treatment only to be told it wasn't a suitable level of treatment. But actually, that NHS therapist helped me to make a decision and to self refer to a charity that specialized in my trauma.

Private therapists, I'm unsure if it's 'leaked' through to their thinking yet, but I certainly felt a shift when I was looking recently. The 'C' seems to send people into a panic before you've even finished the sentence.

Since leaving the NHS route, I've had therapy with a charity and privately twice. What I've found is that a good trauma therapist doesn't need you to have a diagnosis because they work with an understanding of trauma and what I experience as an individual.

 

[Midnightmoon]

Unfortunately, I've never been in the financial position to pay for a diagnosis, so I can't say it's totally pointless. I waited, was diagnosed, then waited again for treatment only to be told it wasn't a suitable level of treatment. But actually, that NHS therapist helped me to make a decision and to self refer to a charity that specialized in my trauma.

Since leaving the NHS route, I've had therapy with a charity and privately twice. What I've found is that a good trauma therapist doesn't need you to have a diagnosis because they work with an understanding of trauma and what I experience as an individual.

I'm glad the NHS therapist was helpful, despite the overall system being less than. I'm a firm believer that their are many wonderful and skilled clinicians (I worked with plenty!) but stuck in a system which is in a mess. And yeah, the 'too complex'/ 'inappropriate referral' 'requires a higher level of care' type feedback, had that too. 2 years waiting for CMHT, had an assessment, not even 10 minutes in told 'too complex', they couldn't offer anything, and they we're refering back to GP, whose hands were tied because that was the only service to refer too...

(And I totally hear you re the cost of private, I'm fortunate that I have access to charity/ specialist support funding)

 

[beaneeboo]

I think its still very new to identify amongst MH teams... (Mines about a year old, no previous diagnosis, now looking at DID too- but that's private) Where as PD they almost like to give ANYONE who is a 'problem' to them and doesn't fit in a nice box, bonus points if you're female. I don't have any NHS involvement, mainly because it's my main trauma trigger, but also because like you the waits are so long, for very limited service, it seemed totally pointless. If you fall in the meantime, you end up with a PD label anyway.

What's available on the NHS, virtually nothing...

There is a complex trauma service in some trusts, but they are often an all in one catch all that I'm convinced doesn't really suit anyone, and again, furthers the stigma. Private therapists, I'm unsure if it's 'leaked' through to their thinking yet, but I certainly felt a shift when I was looking recently. The 'C' seems to send people into a panic before you've even finished the sentence.

I don't want to go too off topic here so will just say this quickly. Wanted to ask you @Midnightmoon if you know about the potential for being referred to various NHS funded dissociative disorder assessment/ treatment clinics in the UK (funding depends on your local commissioning body)? There are a few like the CTAD Clinic (remote or in person) or Pottergate Centre or a major centre for dissociative disorders in London (can look up the name if you want - currently the name escapes me).

If you're not local to any of them, you can ask to be referred (under Patient Choice) which enables you to access remote input from your preferred centre, regardless of where you live geographically-as long as you're in the UK.

If money is an issue for long term therapy, it may be worth a shot.

Sorry didn't know how else to say this. Ok back to CPTSD AND PTSD!

 

[Starfish]

I have a very basic understanding of this topic (really interesting thread btw). So please don't read too much into what I say - just thinking out loud. And I may be waaaaay off.

But I've come to think of the broad difference between PTSD and CPTSD in terms of developmental identity trauma. One occurs generally more outside of (separate from) the development of your sense of identity and who you are (PTSD) and one directly impacts (for worse) / changes the development of your identity, and your understanding of who you are (CPTSD). As in, CPTSD literally warps your self perception of your identity and who you are (negatively). It's not that i think that PTSD couldn't impact your identity and your sense of self, but maybe it's less likely to change the course of how it develops over all? Or there may be a definite change from 'I used to be this, then the trauma happened and now I'm this' i.e. there was a clear understanding of who you were at some point. PTSD could have you feeling like you've lost yourself temporarily (or for longer), whereas CPTSD could make you feel like you never knew who you were in the first place, and you don't feel real to begin with. That it was always difficult to define yourself.

I guess maybe the type of trauma maybe makes a difference too? Repested shame-inducing traumas when you're young can essentially alter the course of who you believe yourself to be (e.g 'bad' / 'not worthy') which then goes on to effect how you interact with yourself and others your whole life. This is more in line with CPTSD. Compare that to someone who experiences a horrific car crash, and if shame comes from that it likely won't impact on that person's sense of over all identity and who they are as much.

This is a really complex topic! I'm not explaining myself well - just my opinion and I may be wrong!

I agree 1000%..... well put!

 

[sidptitala]

the broad difference between PTSD and CPTSD in terms of developmental identity trauma. One occurs generally more outside of (separate from) the development of your sense of identity and who you are (PTSD) and one directly impacts (for worse) / changes the development of your identity, and your understanding of who you are (CPTSD)

Repested shame-inducing traumas when you're young can essentially alter the course of who you believe yourself to be (e.g 'bad' / 'not worthy') which then goes on to effect how you interact with yourself and others your whole life. This is more in line with CPTSD

it wouldn't be called 'complex' if it was so easy and quick to sort out...

Yes, this is how it was explained to me by my therapist- and why it's taking longer than might be expected for me to recover: because my 'before' self also had PTSD.

In society there is a lot of respect for veterans and this could carry forward in to treating PTSD in veterans. I'm not a veteran, my adult traumas have been from relationships and I think there is a lot of victim blaming that exists for my traumas, so I've not experienced the respect that you may have as a combat vet.

I think you're right about this. I wasn't a soldier but worked in civilian protection in war, which probably is even more respected than combat in my country. This was so much less traumatic than being abused as a child was, probably in part because there isn't the intense stigma attached to it.

What I'm noticing recently though is how for some healthcare professionals the C part seems to be an 'undercover' assumption that it's EUPD with a different name, and the stigma that goes with it

Where as PD they almost like to give ANYONE who is a 'problem' to them and doesn't fit in a nice box, bonus points if you're female

100% this. I live a country that uses both DSM and ICD, it depends on the doctor and where they were educated. The first psychiatrist I ever saw (in the Emergency Department) told me I had PTSD for sure and might also have CPTSD and referred me to a clinic to finalize the diagnosis. She must have been using the ICD. The referral literally said, PTSD or CPTSD? The second psychiatrist interpreted this question as PTSD or BPD? This was clear from the moment I met him. And I had to fight not to be diagnosed with BPD (based on nothing other than a history of abuse, employment and emigration choices that dr thought were weird and unstable, and fitting a profile of female patients he had given that diagnosis to).