Complicated case of ptsd

[lostforgottensoul]

Anyway, as long as you experienced a real threat of bodily harm due to a substance or not, this is a criterion A stressor IMO.

But, it's not up to opinions. It is what it is.

The entirity of criterion H says:

Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

PTSD and DSM-5 - PTSD: National Center for PTSD

This would include after effects of drugs as well. Example would be a bad trip that continues to happen.

The OP themselves says:

She said that it would qualify because I felt as if my life was in danger and that I was going to die. It was all of the intense fear of a traumatic experience without the traumatic event; it's not as if it were a bad drug trip.

Bolded for emphasis.

But, a tramatic event is required to fit criterion A. Feeling like you are about to die due to a drug does get disqualified from PTSD.

Personally, if it were me, I would ask for a 2nd opinion and ask specifically about this. Many disorders mock PTSD and there are a bazillon cross over symptoms with PTSD from other disorders. Personally, if it were me, I would highly question this diagnosis.

Of course, though, I am not qualified to diagnosis or say one doesn't have PTSD. Just saying I would highly question this diagnosis, if it were me.

 

[Jim711]

I apologize as I'm new to the forum and I guess I don't know what the culture is. I am making several assumptions which I don't explain, but should whether right or wrong. One was that someone can specify after taking a medication that their physical symptoms are a result of psychological issues, which for the person posting I was curious about. How do you know some of those effects weren't really due to the medication? Second, prolonged physical illness I would consider to be a threat to the physical integrity of the self (as the post mentions) meeting criterion A. Third, concerning my suggestion, the little out there on the etiological underpinnings of C PTSD is that it captures better complex trauma, including prolonged trauma where there isn't a single marked stressor. I would love to hear more about it from the boards though. Anyway, good luck with your treatment. I hope you are able to clarify things further. It is very difficult when your symptoms don't neatly fit into the current diagnostic classification system. It's worse when you dont have the background to tease things apart for yourself. It sounds like you have good support though and I agree with your therapist... read up on CPTD.

 

[lostforgottensoul]

Second, prolonged physical illness I would consider to be a threat to the physical integrity of the self (as the post mentions) meeting criterion A.

That's not in criterion A.

Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

PTSD and DSM-5 - PTSD: National Center for PTSD

Lyme disease is also not life threatening and treatable. Per the medical texts about it.

Lyme disease Treatments and drugs - Mayo Clinic

So that fails to meet the exposure to death, threatened death, actual or threatened serious injury; direct exposure or witnessed.

In my opinion, that is bending the diagnosis to meet the symptoms rather then finding out what the symptoms would fit into.

How do you know some of those effects weren't really due to the medication?

I am not understanding this question. Effects due to a drug, medications or otherwise, disqualies a PTSD diagnosis per criterion H. We are going in circles.

read up on CPTD.

I have, extensively, including the new ICD 11 inclusion of cPTSD.

You have to qualify for a PTSD diagnosis to then be diagnosed with cPTSD. If the trauma cannot be diagnosed with PTSD, then cPTSD is off the table.

 

[waterv1]

That's not in criterion A.

Criterion A (one required): The person was exposed to:...

Honestly, I just want to get the right treatment. Could I ask why Criterion H exists? From how I understand it, I feel as if there is a genuine belief that your life is in danger, I'm not sure how the brain would differentiate between an actual traumatic event and a perceived event. I want the right diagnosis, but I don't want to dismiss the possibility, since this medication directly affects the traumatic memory forming part of the brain and there isn't really much precedent for this specific case.

 

[Jim711]

After some careful consideration, I think the best answer at this point is, as others have suggested, to get a second opinion from a qualified trauma specialist. As you see, there is disagreement among people on how diagnostic criteria are applied, with debates in the literature on definitions, intentions, and contexts where criteria can be interpreted differently (medically complex cases for instance). I can definitely say that your post is aptly named, and I relate. There are many more details that could support or refute a potential diagnosis which could aid your therapist. I hope that my thoughts on the your situation did not cause additional confusion, but perhaps can be a jumping off point for a good discussion with a qualified provider. These are great questions for such individuals.

 

[anthony]

For everyone unsure of the current and soon to be ICD versions, please see: Icd 11 ptsd diagnosis

The first post contains the new ICD 11 PTSD version. A few posts down, the ONLY and not yet released, CPTSD official diagnosis. There is no diagnosis called CPTSD officially, yet, unless you were diagnosed by a therapist in the world participating in the ICD 11 trials, providing feedback to them on their criterion.

What is in that post WILL be the ONLY official CPTSD criterion, once released. It requires PTSD diagnosed as its first criterion.

If you want to read the criterion from the coming ICD 11: Link Removed

I do not believe bullying would ever fit this criterion, as it would have to be compared to domestic violence levels. There would be actual trauma that would need to occur, which then escapes bullying to now actual traumatic events happening.

And please don't use outdated DSM versions: PTSD Diagnosis - What is PTSD? Understand The Signs of PTSD (the official and current DSM 5 in full).

 

[Sideways]

In terms of a way forward, I'd maybe consider 2 avenues:
Firstly, although you've said that you're no longer depressed, you also seem to be describing an emotional numbness? This could indicate that you are still suffering from depression, although it has changed its presentation, which wouldn't be unusual for chronic depression. And that's potentially a glimmer of hope because depression still boasts pretty good outcomes with treatment, albeit that the form of treatment may need to adapt to the way your depression has changed. That might be an avenue you could explore with a T.

Additionally, although I can imagine it must be hugely frustrating to feel like there's no "traumatic event" to work through, I think there's still a lot of benefits you might get from a trauma-based approached to treatment with a trauma specialist.

Partly this is because you do had something very specific you can address: which is the acute impact of taking the medication, as well as the way it's impacted your life which is what a lot of trauma work is about. For example, have you explored the anger and grief aspects with a T and worked through those? Maybe that might help you move forward??

Bt also because as you've described, the impact that your symptoms have on your life today? Are a lot like a person with PTSD. And certainly my experience with my own trauma recovery is that working on my trauma is really only a small part of my treatment. The bulk of my treatment is directed at addressing the problems I currently have. That means work on things like emotion regulation, self-concept, relationships, etc. They are all issues that people with PTSD commonly have to work through with their trauma T to recover, but which don't actually involve examination of the trauma itself. So, finding a T that can work on the way your symptoms impact you today (and not just the underlying trauma) could be a huge part of your recovery journey, and the finer details of your diagnosis don't necessarily have to complicate that.

 

[lostforgottensoul]

Additionally, although I can imagine it must be hugely frustrating to feel like there's no "traumatic event" to work through, I think there's still a lot of benefits you might get from a trauma-based approached to treatment with a trauma specialist.

I agree!

I've been thinking about this and there are many on here that have zero memories of their traimatic event but that still work a trauma therapy program and still move foward. It is all about working through symptoms no matter which way you turn it. And DBT and CBT are very good things to work through no matter what your symptoms are caused by or what defines them.

Another great set of thoughts Ragdoll!

I suppose there is value in knowing what is wrong with you or what is causing the symptoms but when the layers are pulled back, it doesn't matter much as you have symptoms to work with and have to get through those symptoms no matter what.

 

[EveHarrington]

I think what matters most is having a treatment team who is willing to work with you and has a treatment plan for moving forward. Maybe it is PTSD? Maybe it's a yet undefined subtype of PTSD? Maybe it's another disorder that mimics PTSD very closely? You may never know for sure, and that's ok. As I said, the important part is receiving treatment that helps you heal. Maybe trauma work will help you? Perhaps start with traditional trauma therapies and then move on from there. :hug:

 

[joeylittle]

Could I ask why Criterion H exists? From how I understand it, I feel as if there is a genuine belief that your life is in danger, I'm not sure how the brain would differentiate between an actual traumatic event and a perceived event.

To be honest, science is not entirely solid on this, yet.

But, criteria exist to try and render diagnoses as specific as possible. Why? It helps the science and research and treatment protocols to evolve in an organized fashion.

..."threat to physical integrity” was removed from the definition of trauma in the DSM-5. Medically based trauma is now limited to sudden catastrophe such as waking during surgery or anaphylactic shock. Non-immediate, non-catastrophic life-threatening illness, such as terminal cancer, no longer qualifies as trauma, regardless of how stressful or severe it is ...

source: PTSD in the DSM 5: Controversy, Change, and Conceptual Considerations

So, is this just the APA deciding that medical trauma (because I think that's more along the lines of what the OP is describing) doesn't really matter?

No. It is committing to a narrower and more specific definition of trauma. Post-Traumatic Stress Disorder must be, by definition, caused by a traumatic event. And that event is sudden, shocking, catastrophic.

Adjustment Disorder is more likely to be the textbook answer to your situation, @waterv1. When the DSM 5 created the category of Trauma and Stressor-Related Disorders, and located PTSD there, it was joined by two other diagnoses - Acute Stress Disorder and Adjustment Disorder.

ASD is very time-limited. AD is less so. From everything I've read, in terms of differential diagnosis among the trauma and stressor disorders, adjustment disorder is recommended as the next diagnosis to look at, when someone is presenting with sub-threshold PTSD (in other words, something that looks a lot like PTSD but doesn't quite meet all the criteria sufficiently, and/or has an exclusion.)

You might find this article interesting: Adjustment Disorders: Practice Essentials, Background, Pathophysiology

And, this one talks about the issues and controversies surrounding the re-classification of AD: Adjustment Disorder: Current Diagnostic Status

Finally, this is a very readable article on the different ways adjustment disorder presents. Adjustment Disorder Symptoms and Their Effects - Adjustment Disorder - PTSD and Stress Disorders | HealthyPlace

I would not be discouraged by the sense that adjustment disorder is for 'lesser' traumas. Sometimes people seem to have a strong reaction to that idea. And that's really not the point. The point is, there's a broad spectrum of highly stressful events that can have severely impairing effects on people's lives. AD encompasses a big chunk of those, currently.

One article I read dealt specifically with cancer diagnoses, and how they have shifted over time in the ways they address the stress impact of having such an impactful medical event. AD is now part of the oncologists' understanding of how to classify patient reactions that were previously considered a pseudo-form of PTSD (ca-PTSD, or cancer PTSD).

Anyway - I hope something in here might help.

 

[waterv1]

To be honest, science is not entirely solid on this, yet.

But, criteria exist to try and render d...

Thank you so much; you've all been really helpful.

 

[Scarlet13]

So, I just wanted to share my story (abridged version) since you said you were wondering if anyone has experienced something similar. I have C-PTSD from multiple childhood abuse events and from a medication reaction.

I had a baby in 2013 and experienced post partum depression and insomnia. I got 'help' from an SSRI. This med caused a similar reaction to what you describe. My nervous system began to simply feel FEAR. Doctors later called this a manic reaction. I then suffered a horrendous and hellish withdrawal that has lasted for 4 years. I am slowly, gradually getting better, but my nervous system literally completely fell apart for a year after where I had zero sleep and had to take a bento to stay sane. I had to then taper off of the benzo and of course experienced a severe withdrawal from that. My story is confusing, but basically due to genetic reasons, my brain reacts strongly to pretty much all psych meds.

So, basically it sounds like you have suffered an iatrogenic illness or injury. Also, with Lyme some of your effects could still be from Lyme disease. Also, if you have a bad gut, that can cause psychiatric symptoms.

What I have learned about myself, is that I have to treat these physical effects of the physical harm done to me by the drugs I took and tapered from (as prescribed). What works for these biological causes of anxiety and depression is correcting nutritional deficiencies like Vit D. Things like fish oil, magnesium, melatonin, and this one really awesome probiotic have helped me not feel as much biological fear and adrenal rushes.

Also, therapies like CBT and DBT help you reframe and tolerate fear effects until your brain heals itself. I would rec taking supplements with caution and greatly reduced amounts because the nervous system that is dysregulated can be over reactive. This sort of injury is not really well understood by doctors. But the things that help are all good healthy things that anyone should do.

I also have PTSD from this drug reaction, in terms of a mental reaction and spiritual effects. But here is the thing, I already had a trauma basis before having this reaction making me more susceptible to essentially really being scared by the whole thing. I had a physical reaction of fear and then I had a mental reaction of fear to the physical reaction. Really hard to explain. But, the thing that really caused my 'medical trauma' was that my first psychiatrist harmed me by not recognizing the reaction, invalidating me and not helping me. So, it was really the human, carelessness aspect of it.

As I feel better and better, that fear reaction is calming down and I can easily detect my CPTSD. PTSD fear (hypervigilence, flashbacks), is a totally different sort of fear and is more emotional and comes more with triggers, where as the biological fear from drugs and drug withdrawal feels more automatic and random. This effect lasted for like 4 years and is now healing as I heal my gut and I am actually able to deal with my CPTSD. I hope this makes any sense and is at all helpful.