Icd 11 ptsd diagnosis

[DharmaGirl]

As an RN Case Manager, I had a reference book (like the ICD) to bill insurance companies. If you had pneumonia, you had to meet a certain criteria to be an inpatient in the hospital, and for the hospital to bill Medicare. Billing Medicare seems to be the gold standard. Anyway, I viewed the DSM the same way, as criteria to bill insurance. I know you have to fit the categories, however I don't think the therapist or psychiatrist uses it like a lot of people think. A lot more goes into diagnosis than just fitting criteria. I had a discussion with my therapist about this, and he said that he billed PTSD, but called it cPTSD so in his case notes, another therapist would know that it was prolonged trauma. Sort of the culture of the job. In nursing we have things we say that are not diagnoses, but the nurse taking report would understand. I think I thought of it, and still do, as a modifier, such as severe PTSD. I know it is hotly debated here, but I don't think it will change much. Just being able to bill for something that usually takes longer to sort out than the 16 weeks of therapy insurance companies allowed for PTSD therapy. In the US, I should add.

I had a toxic friend who would use the DSM to diagnose all her friends, and she would tell them. I couldn't get her to understand why you can't do that. She couldn't see past the black and white of the criteria. She was a Scientologist, though, and their thinking is strictly black and white. She told me I had Borderline Personality Disorder, so I asked my therapist if I did and he said no, the symptoms overlap. Sorry, went off on a tangent.

 

[lostforgottensoul]

She told me I had Borderline Personality Disorder, so I asked my therapist if I did and he said no, the symptoms overlap

Yes they do, a lot. And, I would say, from this cPTSD criteria, a lot of comobilty of PTSD & BPD may be undiagnosed with BPD and diagnosed with cPTSD. It has been said a lot on here that cPTSD is PTSD + BPD. I have seen that a lot and it looks like cPTSD has the emotional roller coaster and the inabilty to have stable relationships that is more well known in BPD.

But, someone diagnosing me? No bueno! I don't even diagnose me. I will leave that to my therapist, thank you!

I know it is hotly debated here, but I don't think it will change much. Just being able to bill for something that usually takes longer to sort out than the 16 weeks of therapy insurance companies allowed for PTSD therapy. In the US, I should add.

I would agree with this. My insurence started to try to cut off my therapy every single year starting at year 3. I have been with my therapist 8 yrs. Each year we have to fight for another year of coverage, once a week. Unlimited therapy visits doesn't really mean unlimited therapy visits. Their stance, though I have never talked to the insurence's therapist (usually newly graduated or still in school therapist trainees, per my therapist) because they refuse to talk to me, is that it has been "long enough" for me to be "functional enough" to not need therapy. What is "functional enough"? Most especially since my own therapist that talks to me every week says no, it hasn't been "long enough".

I have no idea why there is a limit on how long therapy should be. If I am moving foward or activitly trying to move foward then what's the problem?

So, I would agree with that. So PTSD then it may take X amount of time but cPTSD it may take Y amount of time longer. Makes sense.

 

[DharmaGirl]

Insurance is in the business of not paying. If they can cut you off, they will. I couldn't stand being a case manager, looking at a rubric instead of a patient to say how long they can stay in a hospital. It is such a cut throat business. That is not why I became a nurse.

 

[BlueOrange]

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.

I see it as a positive. ICD is not a treatment manual, or a diagnostic manual; it's a system for the classification of diseases. The DSM has so much noise, and the various attempts to define trauma haven't had much value to them. We don't say to people "You can't have a broken bone, you weren't hit with a hammer," but the DSM attempt to define everything has driven a lot of silly distractions. (In fairness, the Diagnostic and Statistical Manual is a diagnostic manual, and therefore it needs to go into more detail. But it's nowhere near the level of information you'd get in the textbooks that are actually used to teach diagnosis of physical diseases.)

As for the possibility that people will try to use it to fake PTSD, I think that it's harder to fake the ICD definition than the DSM definition. DSM gives you a shopping list of things to fake - ICD requires skilled interpretation.

Trust them, they know what they're doing? ;)

 

[EmmaOwl]

DD-NOS. Dissociative Disorder, Not Otherwise Specified. It covers an awful lot, if you really need a DSM code but don't fit the particular mix for PTSD.

 

[lostforgottensoul]

As for the possibility that people will try to use it to fake PTSD, I think that it's harder to fake the ICD definition than the DSM definition. DSM gives you a shopping list of things to fake - ICD requires skilled interpretation.

Still super hard to fake with the DSM. My dad tried to gain more VA benefits and failed. So PTSD in general is hard to fake but I do agree with that.

 

[anthony]

DD-NOS. Dissociative Disorder, Not Otherwise Specified.

There isn't actually such a disorder. No such thing. There is:

• Other specified dissociative disorder, and
• Unspecified dissociative disorder.

Yes, both are broad spectrum diagnoses, however, this is where dissociative symptoms of a dissociative disorder cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, yet do not meet the full criteria of another dissociative disorder.

The first is used when the therapist specifies the reason full criterion are not met for an existing dissociative disorder.

The second is used when the therapist does not specify the reason full criterion are not met for an existing dissociative disorder.

The therapist can not basically use it to create a diagnosis for anything dissociative. Instead, they are used only where dissociative disorders are present, but just shy of the mark, yet meet the criterion for dysfunction within life.

it's a system for the classification of diseases

Yep... I do like it better than the DSM, to be honest. If you compare DID from WHO with DID from the APA, this is why America is flooded with DID diagnoses now, because the DSM has made it so easy to use, compared to the ICD version.

Psychiatrists can have the best of intention when they create this stuff, for psychiatric use... but the majority of people using the manuals are psychologists, where suddenly a whole lot of emotional interpretation just got added. I love reading about the studies that psychiatrist do against their peers... and just how f*cked up basically they prove the mental health diagnostic system to be. It baffles me we still use it -- yet their is nothing else to best it. Flip a coin, anyone?

 

[anthony]

Still super hard to fake with the DSM.

I think the problem is that when a therapist does not perform due diligence and put the person through all the required assessments, then faking gets through easier. The range of assessments for PTSD will keep a person busy for a couple of hours normally, then the face to face one to confirm whether the results are accurate or not (behaviour, body language, responses, etc). If you can fake all of that, either book won't matter.

 

[lostforgottensoul]

Yep... I do like it better than the DSM, to be honest. If you compare DID from WHO with DID from the APA, this is why America is flooded with DID diagnoses now, because the DSM has made it so easy to use, compared to the ICD version.

I am wondering, since ICD is international and WHO seems (to me) to have it together more then the APA, that the ICD could replace the DSM one day and become the universal book all countries use?

I am not sure if that makes sense and likely it's all about money, like everything else, but if ICD is, and historical has always been, more accurate, then why not make it the universal book and tool used by everybody?

 

[EmmaOwl]

There isn't actually such a disorder. No such thing. There is:

• Other specified dissociative disor...

Got it. I was working from DSM IV R. Sorry. I'm out of my depth here so I think I'll stop posting on this thread.

 

[joeylittle]

From a 2009 piece published in the APA journal, "the monitor":

There is little justification for maintaining the DSM as a separate diagnostic system from the ICD...But, said [Dr. Geoffrey] Reed, [WHO] "there would still be a role for the DSM, because it contains a lot of additional information that will never be part of the ICD. In the future, it may be viewed as an important textbook of psychiatric diagnosis"...

Link Removed

I think both sources will be useful until there are absolute, quantifiable means by which to confirm mental health diagnoses.

The two documents are heavily bound together simply because of the usefulness of diagnostic codes for billing, insurance, tracking purposes.

But, they also provide a useful push-pull that is healthy for the field as a whole. So long as one must keep up with the other, and our understanding of mental health issues is evolving, there will always be benefits to be gleaned from differences in criteria.

It's possible to make a case, in the US, for allowing a diagnosis based on information in the ICD that is different for what is described in DSM.

The run of the mill conditions might not need this, but individuals dealing with more nuanced challenges may well benefit from being able to support an argument for care, using whichever of the current ICD or DSM best addresses their needs.

 

[anthony]

become the universal book all countries use

The ICD is the universal book all countries use. America uses it. The difference is that America decided to create their own book for mental disorders. The APA have no intent of letting go of the DSM cash cow. It raises them hundreds of millions over the course of each publication. Then, the DSM is a specific mental health manual which contains psychiatric and diagnostic data about conditions that the ICD does not, chances are, will never.

It creates a divide in some instances -- it answers why America is the most pathologized country in the world for mental health -- when used together with commonsense and experience, they can both provide aspects the other does not as food for thought before slapping labels on people and possibly destroying lives.

@joeylittle actually said it well when used in balance -- they provide a push pull that is healthy overall for mental health.