Icd 11 ptsd diagnosis

[EveHarrington]

So, does the new criteria make it easier or harder to "have" ptsd. I spend a lot of effort trying to co...

It looks harder.

I can look at the DSM criteria and say "yep, I concur with my diagnosis!" but with the ICD I cannot say the same. I'd possibly go either way depending on the interpretation of the criteria.

 

[anthony]

If you look at the study linked in the first post, WHO are saying from 228, using (diagnosed):

• dsm 4 - 43
• icd 10 - 62
• icd 11 3 factor - 51
• icd 11 2 factor - 56

They all meet the full criteria, with impairment.

Like I said, studies are all quite subjective. This study was based on trying to prove ICD 11 new criteria is better. Knowing what I know about the DSM 4 criterion, I call total bullshit on 43 meeting it. It was a "give me" for PTSD, that version. Now if you wanted to prove ICD 11 is better, then you would be stricter on meeting criterion for others, do less work on poking and prodding the person for the impact of their symptoms, and rely purely on written assessments and such (self-reporting).

Long story short, the ICD 11 has made it harder in some contexts, but all they've really done is shift the narrative to a more focused symptom set. So if you took that focus and applied it to 228 people, then they would be a different group than the other groups. There would be cross over with severe persons, but likely people who didn't meet criteria under other models now meet criteria for the ICD 11, vice versa.

They're trying to focus the symptom set to the core symptoms, and exclude the rest. I don't know whether that is good or not, time will tell us.

What I will applaud them for, is that they are taking a different stride and going against the primary problem of the DSM, criterion creep.

When you look at table 3 in the linked study, you can see that the mild / moderate group is the largest that took the hit to no longer meet criterion. Small, but a 50% decrease. Medium and severe were about the same across the board. When you look at it like this, then it will likely limit the mild cases from diagnosis, which is good from a diagnostic view (the borderline cases), but can cause issues elsewhere too.

The sample size is small in relation to diagnosis for a disorder. Statistics will tell after a year or two of its use whether this is the actual case or not.

 

[anthony]

but with the ICD I cannot say the same

This is what will make cPTSD more interesting than many think, as the first criterion for cPTSD is that you have met PTSD. Not sure WHO made it in a way to cross-over with the DSM version, but their version only.

Countries that use both can probably use things loosely, as that is very mental health-ish already. But in countries where only the ICD is used... fun times ahead for those with cPTSD but do not meet the original PTSD criterion.

 

[lostforgottensoul]

fun times ahead for those with cPTSD but do not meet the original PTSD criterion.

But how would that happen? I mean, in my understanding, CPTSD is a subset inside of PTSD. Just a longer more severe (for a lack of a better term) trauma. So to meet CPTSD, you'd have to meet PTSD first anyway, in my understanding. What am I missing?

 

[anthony]

So to meet CPTSD, you'd have to meet PTSD first anyway

Well, what you raise has never been the case though based on all the flip flop cPTSD versions running around the web, all of which are not official. Technically, we still do not have an official cPTSD diagnosis. If you're in America and have been diagnosed, you have been done so as PTSD. More recent diagnoses in European countries where WHO is prominent as the diagnostic manual, they may have been done using the beta version of cPTSD under trial conditions by a therapist participating and feeding back to WHO.

All the present bungled versions are not PTSD, they're BPD + DID + somatisation disorder, all co-mingled, cut and paste from, to create cPTSD versions, both Herman and Van Der Kolk (DESNOS) versions are along these similar lines. PTSD was not used.

See the issue with the entire concept over the past decade? People running around doing their own thing, diagnosing clients with a diagnosis that doesn't exist, let alone is agreed upon, let alone has anything to do with actual PTSD itself. Herman grabbed the name for the attention, but the criterion were vastly different. Van Der Kolk went even more wayward to the personality disorder spectrum.

Long story short -- cPTSD is a cluster f*ck with no actual diagnostic framework yet (ICD 11 is in beta draft form)

You have all these people on this forum, online in general, claiming cPTSD diagnosis by their psychiatrist / psychologist. OK -- what diagnosis did they use? Where is the factual, accredited, diagnostic criterion being used to make this?

No treating physician can provide it, because it didn't exist until the current ICD 11 beta draft -- and that is not open to all and any physicians, as its not legal or approved yet. Those using it must be part of the ICD trial and providing feedback to them, otherwise it too is worthless. Just words, no substance.

Back to long story short -- cPTSD is a cluster f*ck to date.

 

[desiderata310]

You have all these people on this forum, online in general, claiming cPTSD diagnosis by their psychiatrist / psychologist.

THIS. I actually got into a big argument with my therapist over this.
He kept pushing the idea that I had CPTSD :rolleyes: Based off the idea that it was prolonged and repetitive. Yada Yada Yada...
I argued back that this was NOT an official Dx and he couldn't use it.
Officially he can't. For the purposes of insurance he uses PTSD.
I'll stick it the PTSD dx, THANKS. That's plenty bad enough.

 

[lostforgottensoul]

cPTSD is a cluster f*ck to date.

Wow, yeah. I agree that's a f*cking cluster f*ck!

You have all these people on this forum, online in general, claiming cPTSD diagnosis by their psychiatrist / psychologist. OK -- what diagnosis did they use? Where is the factual, accredited, diagnostic criterion being used to make this?

Yeah, I have seen a lot of "I have been diagnosed with cPTSD and I am thinking "how, its not in the DSM or ICD yet". Until now that is. But before this people were running around saying cPTSD and that confused me. Your post makes that a bit easier to understand how that happens.

I argued back that this was NOT an official Dx and he couldn't use it.

f*ck! GO YOU!!

I'll stick it the PTSD dx, THANKS. That's plenty bad enough.

Right! I argued with each disorder and screamed at my therapist asking if he wanted to add any more letters to my record.

Though, that was based off more letters equates to more "crazy, f*cked up forever" thinking. But still!

 

[desiderata310]

based off more letters equates to more "crazy, f*cked up forever" thinking.

At the end of the day, I have to ask, does it matter? Will it really change if you can help me get from where I am with my current state of mental health to a place where I no longer have flashbacks, dissociate, panic attacks in public, nightmares, etc? If it doesn't, you can call it Purple Taco Saturn Derailment or Cocoa Purple Taco Saturn Derailment for all I care. I just want to not be like this forever.

 

[Deanna]

I was diagnosed PTSD but it goes back to my childhood. so I thought it was cPTSD ( Hanging around the forum) My bad, I guess./

 

[anthony]

My bad, I guess.

Most people don't understand the labelling, they just believe whatever they read, or whatever their physician tells them. I would think you could believe your therapist / psychiatrist, but even they use labels as though they exist, when they don't. They just don't tell the client that.

Labels are just labels. To be honest, the entire mental health diagnostic system is broken. Yet at the same time, its the best we all have at present. What the future brings, who knows!

Like @desiderata310 touched on about symptom progression -- its the cause that needs to be treated. Treat that, the symptoms are a causal affect, they don't exist by themselves. Target the right cause systematically, the affect reduces / disappears. Causal notions are a little more than this, but that is the basic gist.

 

[Deanna]

Agreed. I never really thought about the labels, but they do exist. I know I was embarrassed the other day because someone came up from behind me and I totally freaked out. ( I don't mean screaming or anything) but my eyes went a little crazy and the effect lasted longer than it should ( for a joke or normal person) and so the person that saw me react knew it a wasn't normal reaction. I couldn't hide it ( which I usually can do well) but... I agree with what @desiderata310 said.. about symptom progression.

 

[lostforgottensoul]

If it doesn't, you can call it Purple Taco Saturn Derailment or Cocoa Purple Taco Saturn Derailment for all I care. I just want to not be like this forever.

Agreed! Though, my only thing with labels and making sure you have the right ones that actually do fit is therapies specific for that disorder. So, for PTSD an example would be EMDR. Specific for PTSD but if the person has some symptoms that mimics PTSD but doesn't have PTSD but rather one of those other disorders, EMDR may not be a good therapy for them. Or, for cPTSD, like Anothony said, they would do DBT and/or CBT to stabilize the person first before trauma processing. That may not be the same for a PTSD person. So, that's my only thing with labels and making sure you have the right ones.

Also, say hypotheticly I fit cPTSD and was diagnosed with cPTSD. Maybe I also would not be diagnosed with BPD. I have many BPD symptoms (enough for diagnosis) but those same symptoms are listed here for cPTSD. My therapist (and yesterday, my pain doctor) said I do not act like the "typical BPDer" and my therapist says he sees mostly PTSD in me. My pain doctor said "I would have them recheck that diagnosis". The missing link, per both of them, is manipulation. I even argued with my pain dr telling him I did (was told I did) manipulate without meaning to and that is when he threw out examples of a "typical BPDer" and what, he said all, do to manipulate and told me that he has not seen one sign of BPD in me. He also said that even if I didn't tell him, he would be able to spot it based on manipulating him and his staff and any other companies involved. My therapist did the same thing, give examples of how a "typical BPDer manipulate, which I have never done.

So, I don't know, but I think having one single diagnosis, cPTSD, would be a f*ck load easier and it would be something that would fit better then PTSD and BPD per the above views.

I also had to stabilze first via DBT and medication, before we could really dive into trauma processing. I mean, really dig into it. Would it have taken so long to stablize me and process trauma if they had cPTSD and these guidelines, or whatever you call them?

Though, they may be able to do that with just the symptoms. I don't know.

I think insurence companies also play a big part in that. At least in the US. Not sure if this is all of of them but you have to have a disorder listed for them to cover you. That, i believe for me, is GAD as anxiety comes with PTSD and the proposed cPTSD so, to me, it is an unneeded label. So, maybe that is why many therapists quickly give you at least one lable. Insurence reasons. PTSD maybe that quickly given label.