Icd 11 ptsd diagnosis

[Sideways]

I have a small issue with the argument: "If it isn't officially in the DSM or ICD then it doesn't exist..."

If you need my DSM diagnosis, I have PTSD. If you want some more information, I have complex PTSD. As opposed to, say, combat PTSD.

If a person came to me and said "I have arachnophobia, and I'm about to start exposure therapy for that", I'm going to have a pretty good understanding of what their issue is. A much (much) better understanding than if they said to me "I have a Simple Phobia".

Simple Phobia is the 'official' diagnosis, and Arachnophobia doesn't "exist" in the DSM. To the person dealing with the Arachnophobe, whether it be a supporter or pdoc or whatever, "Arachnophobia", for all that it doesn't technically 'exist', still works for me as a pretty helpful way for that person to tell me what their mental health condition is.

Neither the DSM nor the ICD have a monopoly over the way we define or describe our health issues. In some circumstances (like when you're claiming insurance), you have to use the prescribed diagnostic guide when describing health issues, but that doesn't mean that anything outside those issues "doesn't exist".

 

[anthony]

I have arachnophobia

I'm not disagreeing with you. My issue would be if you changed that and said, "I am diagnosed with arachnophobia..."

Big difference between the two. I suffer, I have, I'm diagnosed. First two are explanations, the third is a claim to a diagnosis that does not exist. The third is no longer describing, as the first two are, the third is stating a fact of diagnostic application.

 

[Sideways]

@anthony - absolutely. But, we are starting to get into pretty fine detail about the precise language and intention by that point.

Suffice to say, a person might go to doctor and say: Can you help me, I think I have arachnophobia? It's not exactly helpful for the doctor to say "Pishposh, there's no such Diagnosis".

Likewise, a doctor might say to a patient: You seem to have a nasty case of arachnophobia". The patient would be doing themself a bit of a disservice by retorting that "Sorry, but I need a diagnosis." It's not a diagnosis that will cut the mustard on a Medicare form, but in any other setting, Arachnophobia is probably going to be acceptable as a 'diagnosis'.

Same deal here. A person who says to me, or their GP, or anyone: I've been diagnosed with combat PTSD... The DVA may take issue with that, because suddenly what does/doesn't constitute combat PTSD may be a big deal, and Medicare is going to want a DSM-specific 'diagnosis. But in almost any other setting, using additional words to clarify the type of PTSD is helpful, even in trems of "What's the diagnosis?" People with Severe PTSD don't have a non-existent diagnosis, they have PTSD, and someone has decided that their PTSD is severe.

It doesn't seem to be diagnostically 'incorrect' to clarify medical diagnoses using 'unofficial' terms - eg. "He has advanced dementia" wouldn't be rendered an incorrect or nonexistent illness by adding the clarifying "advanced". So, unless I'm Medicare and need to be able to encode it, why would I need a "proper" diagnosis to come straight from the DSM or ICD?

It does become a problem when the "clarifying" word may add more confusion than clarification. "Complex" PTSD has that problem I think - but if a pdoc says to a person "Your diagnosis is Complex PTSD?", it may be more useful to ask "What do you mean by complex?" rather than decide that's an invalid, or 'non-Medicare-approved' diagnosis.

 

[Deadman]

If you want some more information, I have complex PTSD. As opposed to, say, combat PTSD.

Fair warning. I'm being provocative. Whats the difference between combat PTSD and complex PTSD as you've used the terms?

 

[Sideways]

Whats the difference between combat PTSD and complex PTSD as you've used the terms?

My examples are skewed towards personal experience, and as pointed out above, combat ptsd could easily be considered a type of complex ptsd "by default", because it's an experience of "chronic" trauma (rather than single event trauma) which seems to be the pivotal factor in the "complex" version of ptsd.

So short answer there? Combat ptsd could be a form of Complex PTSD. Which could both be a form of PTSD.

Personally if I had to define them all? I'd make them different, because effective treatment seems to be different and to me that should be relevant when we knock together diagnostic criteria.

Your point definitely highlights that we don't actually seem to have a good understanding of what it is that makes complex PTSD different. Which is why, as it currently stands, if a person is currently diagnosed with Complex PTSD, the question is "What do you mean by Complex?" rather than dismissing the diagnosis as invalid or non-existent. Here, I think a lot of pdocs would tell you Complex = Chronic (as opposed to Simple = Single), so yeah, combat ptsd would probably always be complex.

I think it all needs a lot more work, but starting with some sort of recognition that these 2 previous synonymous conditions have important differences is a good start. Personally, just because effective treatment approaches are different, and the symptoms causing the most dysfunction seem to be different, I would distinguish between combat ptsd (where hyperarousal symptoms seem to take on an all new meaning) and trauma from chronic abuse, which seems to cause huge dysfunction with the concept of 'self' in particular. Some people are stirring a concept of Developmental PTSD into the mix, or at least developmental trauma, which seems to be nidging at the same issue. Idk, I've got far more opinion than qualifications on this.

 

[BlueOrange]

I'm hopeful that diagnoses based on Structural Dissociation will take over.

PTSD is a hopelessly confusing label. There are so many disorders that relate to traumatic stress.

I find it frustrating when people say "X isn't a disorder" when it would be more accurate and precise to say "X disorder isn't listed in [sources]." I think that it gets in the way of helping sometimes.

I'm also sympathetic to the need to focus and to have some way of limiting how many of the world's problems we try to solve.

 

[anthony]

Your point definitely highlights that we don't actually seem to have a good understanding of what it is that makes complex PTSD different.

I will disagree with this. There has always been an exceptional understanding of what defines complex PTSD. And it is not about prolonged trauma alone. The ICD definition linked on the first page is very accurate and follows the lines of all original research based on clinical representation, performed by those such as Herman, Van Der Kolk, and colleagues. From the get go, the understanding has been pretty clear. It was more a matter of actually defining diagnostic criterion, without doing what all have done prior to ICD 11, trying to mix personality disorders and other disorders, yet call it PTSD at the same time. The ICD 11 have done a really amazing job at separating out the specifics and outlining a diagnostic criterion reflective of the personality traits, yet focused on the root cause, trauma.