News Criterion A Revision! Better Or Worse?

[anthony]

DSM IV-TR Version (Current)

The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others​

(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior​

The Current Proposed Revision (In Clinical Trial)

The person was exposed to one or more of the following event(s): death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways: **

1. Experiencing the event(s) him/herself
2. Witnessing, in person, the event(s) as they occurred to others
3. Learning that the event(s) occurred to a close relative or closefriend; in such cases, the actual or threatened death must have been violent or accidental
4. Experiencing repeated or extreme exposure to aversive details of the event(s) (e.g., first responders collecting body parts; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

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I like the new revision myself. That opening sentence really tightens up what is traumatic vs. distressing, and the following selection criteria are then only met based on meeting that opening sentence.

I have no doubt though that some treating physicians will still screw this up with their "loose" terminology of "series injury" and try and do what is being done now, by applying psychological serious injury vs. actual serious injury. That is already one loophole I see, yet it is certainly tightened up significantly in the newer revision.

I hope that distinction is made within the text of the disorder (its instructions for use).

 

[Innordinate]

Sounds like that means you can be dx with PTSD because you learned that a close relative died accidentally. And so basically all the supporters here now have PTSD.

What am I missing?

 

[Innordinate]

Perhaps a new disorder could cover the "learning that the events occurred" should be looked at. They could call it Post Information Stress Disorder or PISD for short. But seriously, what am I missing? I don't think it should be made easier to fit the criteria and I think that's what the new revision would do if it stays that way. PTSD will definately become the new ADHD fad diagnosis.

 

[anthony]

Sounds like that means you can be dx with PTSD because you learned that a close relative died accidentally.

You always could, but don't miss:

"in such cases, the actual or threatened death must have been violent or accidental"

You cannot have PTSD due to death of natural causes, and I think physicians will be pulling their hair out differentiating between the new Adjustment Disorders and PTSD. Quite honestly, I think it should be mandatory that before using (c) the person has been previously diagnosed with adjustment disorder and treated that way first, to rule it out.

Again... I still see scope for physician abuse and manipulation in countries / locations, where times are hard and they want $$$$, or patient numbers are just down and need boosting.

I do agree though... having that C criterion as a secondary will open-up interpretation.

Before you had a two part criterion A, which you still really do have now, they just got rid of the (1) and (2)... still reads the same though in some instances, better in some places, worse in others.

 

[sea]

1. Learning that the event(s) occurred to a close relative or closefriend; in such cases, the actual or threatened death must have been violent or accidental

This seems bizarre to me. So if a relative died in a meat grinder or some such and I told someone about it....what, they'd flashback to me telling them about it over and over? They'd imagine the death or something?

How exactly does a person become traumatized by something like that enough to develop an incurable disorder based around said information? Sorry, I just don't understand it in the slightest. I read the response to Innordinate and it still doesn't make sense to me.

It reminds me of people who say they have PTSD from having a bad dream or or being given a dirty look, or from watching a movie or something. Everybody in the world has heard information significantly distressing and disgusting and gory and violent. All the supporters on this forum have heard information like this....?

The rest of the changes seem legit, though.

 

[Meadowsweet]

It seems such a complex issue with many factors that make a distressing incident become trauma. I spent some years being punched on a regular basis, injury was superficial and it wasnt traumatic. The last incident of that relationship involved being locked in and the incident that eventually led to ptsd involved being held down. I can only speak from a personal perspective, but I believe being trapped or helpless is a contributing factor, and this isnt mentioned in the second criteria.

 

[anthony]

So if a relative died in a meat grinder or some such and I told someone about it....what, they'd flashback to me telling them about it over and over?

No, that is not what that says.

It exists for such circumstances as follows:

• You lived with a relative for a part of your life who you become really close with, suddenly they were killed in a plane accident and you have been notified of the event, or
• You have a really close friend, that you have known for 20 years of your life and actively been involved in each others lives for that past 20 years, they are suddenly killed in an horrific head on car crash.

They are two examples of how that statement is used. Its not that 'your' relative died and you told someone else, because that person you told, unless they're a close relative, it would not apply.

This is where ambiguity is being opened up IMO in what is otherwise quite a good modification of the criterion, being physicians can interpret "close friend" and "close relative" for themselves.

What defines a close friend or close relative? Well, it would have to be someone who you are in constant contact with and are a part of your life, and have been for some duration. You could not call someone who you have hung out with for a year, a close friend IMO... but then a physician may do just that if convinced by the person.

This one statement in criterion A is where things are going to get untidy IMHO, because that one statement directly crosses into the corresponding Adjustment Disorder, which deals directly with long term bereavement and the experiencing of symptoms for loved ones, family and friends.

I think any physicians worth there salt would have to go that route before jumping to PTSD.

The problem with all mental health diagnoses is that the treating physician isn't part of your daily life, so they only can use what is being said to them, not the real facts of the persons life itself. This is what makes mental health diagnoses extremely difficult to get right compared to medical diagnoses which have physical symptoms in front of the treating physician at the time, to be adequately analysed for possible causes. Psychology can be made up for the most part on the spot by any good liar / malingerer.

And let me just say... if the person isn't going way out left field, it would be very difficult to pick, especially whilst trying to be somewhat empathetic to their issues. What do you say... "I feel for you and hear your pain, but I think you're full of shit!"

 

[sea]

• You lived with a relative for a part of your life who you become really close with, suddenly they were killed in a plane accident and you have been notified of the event, or
• You have a really close friend, that you have known for 20 years of your life and actively been involved in each others lives for that past 20 years, they are suddenly killed in an horrific head on car crash.

Even so, I still have to say I don't get it :p

Doesn't there already exist a disorder to define this anyway? Wouldn't it fall under grief disorder rather than trauma disorder? As you said, adjustment disorder or complex grief...

Like...IMO anyway, there is a difference between a police officer being exposed to dozens of horrific accounts/pictures/statements/information/etc over a number of years vs hearing one piece of information about anybody, regarding an event that you may not even have any experience with at all, let alone significantly enough to be permanently traumatized by it...close relative or not.... isn't there?

I mean, what difference does it make what kind of event it was? Violent or accidental or hell, in their sleep? The grief reaction is pretty much the same regardless? The relative is gone and the patient is still grieving. What it's basically making it about, according to that wording, is any death that "sounds bad" is significant enough to diagnose PTSD upon hearing it...it's a little ridiculous. Is it just me?

I mean there are instances of people who never, ever get over the loss of someone, constantly dwell on it, and are seriously disrupted in function in their daily lives about it even years later, but that is already covered under a different set of disorders. All of this just seems erroneous. It reeks to me of the DSM accommodating the patient (patients who are continuously diagnosed with PTSD over non-traumatic events), rather than seeking to define proper psychological lines.

Plus like you said, how the hell do you define something as subjective as that anyway? What constitutes as "close friend" or "close relative"? Adjustment & grief disorders much more clearly outline all of this in a more concise and all-inclusive way. I don't know if I'd trust anyone willing to diagnose someone with PTSD because they heard about the death of one of their relatives... close or otherwise.

I guess that is just my issue, though. A lot of people come through this forum, and I have to resist saying something to the effect of your last line...Maybe that is invalidating and dickish, but I just can't help it. Sometimes the disconnect is gigantic for me.

IDK. It's super iffy, IMO, but I'm not a doctor I guess.

 

[anthony]

I agree Sea... I can see that one statement in the criterion causing massive issues with diagnosis. I personally think the APA need to get rid of that one statement... it will bite them on the arse big time.

 

[amethist]

OO they are going to have fun with that one.

I could give you at least 3 examples now of how hearing of a close friend dying and been told how. But not being there and seeing what happened, could be used by some psychologist when they see the money rolling in, and those who will try it on for the DX.

 

[intothelight]

But then "Big Pharmacy" wouldn't have all the new guinea pigs to feed drugs too. And then what would the Dr's do with all of the "free" samples?

Tighten the diagnosis criterion and then you don't have much room to generate more revenue.

:mad: