Other CPTSD = Borderline?

[Weemie]

i don’t agree that cptsd is just renamed personality disorder and am happy it’s finally in the icd-11 as its own thing.

What different symptoms from PTSD does CPTSD actually introduce, that aren't covered by other, already existing disorders?

I don't dispute that complex trauma exists, nor that complex trauma creates different problems to single-event oriented trauma. But by including it in a diagnostic manual and making it a separate disorder to PTSD, the claim is that having complex trauma can result in its own disorder that has enough novel symptomology to be classified separately to any other disorder. Which... it doesn't.

All of the symptomology introduced by CPTSD in the ICD-11 is better explained by personality, dissociative or attachment disorders comorbid to PTSD. Keeping in mind that all a PD is, is one's fixed/stable traits and relational orientation.

i do think the new icd-11 approach to personality disorders is interesting and maybe helps destigmatize.

I do agree with this. There's merit to having different descriptors, but having PD as a spectrum between functional and non-functional and broadening it to a simple definition (pervasive divergence of fixed/stable traits) is vastly superior. I do think that having subtypes would be more accurate, but it wouldn't bother me to be diagnosed as just Personality Disorder instead of SZPD.

However, it might bother me more if the only label I knew about was just "Personality Disorder" and I didn't know what schizoid was. Because I know, the diagnosis is less important. But in 20 years if that labeling disappears entirely, simple "Personality Disorder" is not going to cut it for people with schizoid or BPD, which both have very distinct features. Which is why the distinctions can be assistive.

(To that end, it would probably be better to also create a spectrum of schizophrenia that includes schizophrenia, schizotypal, schizoaffective, schizophreniform and schizoid - but I digress.)

 

[OM_™]

This Australian site has some very good info available re CPTSD > Blue Knot Foundation. Just putting it out there... I'm not an expert here. I'm having enough trouble with my CPTSD and MDD and all these distinctions are doing my head in. I just want to feel good and be happy...sorry, having a rough day!

 

[brokenpony]

What different symptoms from PTSD does CPTSD actually introduce, that aren't covered by other, already existing disorders?

I don't dispute that complex trauma exists, nor that complex trauma creates different problems to single-event oriented trauma. But by including it in a diagnostic manual and making it a separate disorder to PTSD, the claim is that having complex trauma can result in its own disorder that has enough novel symptomology to be classified separately to any other disorder. Which... it doesn't.

All of the symptomology introduced by CPTSD in the ICD-11 is better explained by personality, dissociative or attachment disorders comorbid to PTSD. Keeping in mind that all a PD is, is one's fixed/stable traits and relational orientation.


I do agree with this. There's merit to having different descriptors, but having PD as a spectrum between functional and non-functional and broadening it to a simple definition (pervasive divergence of fixed/stable traits) is vastly superior. I do think that having subtypes would be more accurate, but it wouldn't bother me to be diagnosed as just Personality Disorder instead of SZPD.

However, it might bother me more if the only label I knew about was just "Personality Disorder" and I didn't know what schizoid was. Because I know, the diagnosis is less important. But in 20 years if that labeling disappears entirely, simple "Personality Disorder" is not going to cut it for people with schizoid or BPD, which both have very distinct features. Which is why the distinctions can be assistive.

(To that end, it would probably be better to also create a spectrum of schizophrenia that includes schizophrenia, schizotypal, schizoaffective, schizophreniform and schizoid - but I digress.)

i mean, i think that probably the dissociative disorder + ptsd comorbidity does explain things for me. more than the bipolar ii comorbid dx i also have and think is probably not correct. no PD seems to really fit (not just according to my self-eval but my several MHPs over 6 years) but possibly i could fall into the new more generalized ICD conceptualization. i have also wondered about the thing called “quiet bpd” or milder avpd for me, a “non-typical presentation” of one of these PDs or both. but it’s always “not quite,” and not stable across time and situations, even if i “could see it.” the DD really seems to fit but it’s also the laughing stock of the mhc (again). i wish they would just call it something like “complex dissociative disorder.”

the only other thing i would say, which my original comment mentions, is that cptsd is not as it stands a developmental trauma disorder in the ICD. many have talked about it as a disorder of developmental trauma only and this is in part the rationale for it being a PD issue (with its fixed organization across time) but it seems that cptsd (vs classic ptsd) symptomology can appear after adult complex trauma, which the ICD makes room for. i’m under the impression that repeated interpersonal trauma and especially coercive control such as DV or cult abuse after childhood can create the additional cluster of symptoms in an adult that were not (at least clinically) present in them before. that may be incorrect, however.

it’s certainly complicated. possibly rather than a separate dx it could have just become another ptsd subtype. it is a bit weird to me that it requires the core symptoms + another set and they didn’t just make a subtype.

i understand the feeling that you would lose something, important language for treatment or understanding, if schizoid no longer existed as a dx. the bpd specialists fought for the borderline qualifier for that reason. i don’t know much about schizoid beyond the DSM criteria. no one ever seems to talk about it.

 

[Rose White]

many have talked about it as a disorder of developmental trauma only and this is in part the rationale for it being a PD issue

This makes a lot more sense to me now that I’ve been thinking about and reading about the overlap of PD’s with PTSD (and I’m probably talking about the C).

cptsd (vs classic ptsd) symptomology can appear after adult complex trauma, which the ICD makes room for. i’m under the impression that repeated interpersonal trauma and especially coercive control such as DV or cult abuse after childhood can create the additional cluster of symptoms in an adult that were not (at least clinically) present in them before. that may be incorrect, however.

And after reading that PD’s are moderately heritable then maybe people who develop CPTSD after adult complex traumas were already genetically vulnerable to PD’s and the complex traumas in adulthood were enough to switch those genes on, in a number of cases.

In terms of the spectrum of PD’s getting congealed, I did find it interesting that the genes which make people vulnerable to BPD are the same that can lead to bipolar and schizophrenia. When I was reading about the genetic component of PD’s I read that people with the gene which can make them vulnerable to alcohol addiction are more likely to be unmarried and low wage earning, which the researchers hypothesized was because they were at high risk for PD’s. So I’m thinking that from a neurological perspective the PD’s might have a common and similar origin but the flavor of expression varies. If true, I don’t know how that would inform treatment, but it is rather interesting to me and maybe someday there will be targeted interventions.

Suddenly wondering what it would be like to live in a world without PD’s. It would certainly be a different world.

 

[Weemie]

but it seems that cptsd (vs classic ptsd) symptomology can appear after adult complex trauma

Generally, personality disorders are only diagnosed in adulthood as well. The only personality disorder that requires symptoms before the age of 15 is ASPD, actually.

i’m under the impression that repeated interpersonal trauma and especially coercive control such as DV or cult abuse after childhood can create the additional cluster of symptoms in an adult that were not (at least clinically) present in them before.

We actually have another diagnosis that occurs when one's identity and worldview vastly changes as a result of coercive control, brainwashing and cult abuse - OSDD-2.

OSDD-2 describes a dissociative identity disturbance caused by "prolonged and intense coercive persuasion".[1] The DSM gives the examples of "brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, recruitment by sects/cults or by terror organizations." People with OSDD-2, as a result, experience distressing changes to and/or questioning of their identity.

To me, this is still not significant enough to warrant CPTSD as a separate diagnosis, since PTSD + OSDD-2 would be sufficient. Additionally, while CPTSD involves aspects of fixed/stable traits, not every person with complex trauma with PTSD should be diagnosed with CPTSD, if they don't have these symptoms. Which not every person will. This is why PTSD ought to be the baseline.

While, every person that has PTSD is going to have PTSD symptoms, not everyone with even complex trauma that causes PTSD, is going to have alterations of identity or fixed/stable traits especially if these events occurred in adulthood. And it looks like they've already determined this, which is why OSDD-2 exists for significant changes caused by coercive control in adulthood.

i don’t know much about schizoid beyond the DSM criteria. no one ever seems to talk about it.

The prevalence for schizoid is about 0.9%, and most people with the disorder do not seek out treatment (for obvious reasons). I'm an outlier in this regard, too. Heh. Sadly because of the actual symptomology of schizoid (making studying it under voluntary conditions exceedingly difficult - a majority of the information we have on schizoid comes from forensic psychiatry), that we would present ourselves to the greater psychiatric community is very uncommon. Zachary Wheeler has written the schizoid handbook which remains the primary source of clinical information about the disorder. If you'd like to learn more I recommend starting there!

it is a bit weird to me that it requires the core symptoms + another set and they didn’t just make a subtype.

We had a thread here a while back where people wondered if we should list complex trauma, combat trauma, etc as their own diagnosis - I disagreed with this because sometimes people have symptoms of trauma subtypes without actually having experienced that type of trauma (for example I have symptoms of combat PTSD without having been in the military - the most effective treatment for me has been those targeted to violent offenders and military personnel. But if we made this a diagnosis, potentially it would exclude people like me, and interfere with our ability to receive treatment that improves our quality of life).

But having it be an optional modifier might be a good solution. I think, rather than making a subtype of PTSD, greater effort should have been made to classify types of trauma. Complex, combat, developmental, single-event, childhood, adulthood, etc. One wouldn't require a diagnosis of "PTSD + combat trauma" (it would still just be PTSD + whatever comorbidities arise). Having it listed as an example of criterion A would provide clinicians with the tools they need to pursue treatment in these cases, and offer legitimacy to people who believe that these variations in trauma cause additional problems.