Is this PTSD? Your opinions welcome. Scientific question, really.

Gibson

Policy Enforcement
When arteries burst or bones break, diagnosis is easy. When something's broken inside, diagnosis is harder. The lines are blurred. I'd like to think of the blurry lines in psychiatry like the blurry lines of the rainbow. If you ask people how many psychiatric diseases there are, it's like asking how many colors are there in the rainbow? Some say seven colors, some say there's thousands of colors, and both are right.

The main colors of psychiatry are these:
  • F00-F09 Organic, including symptomatic, mental disorders
  • F10-F19 Mental and behavioural disorders due to psychoactive substance use
  • F20-F29 Schizophrenia, schizotypal and delusional disorders
  • F30-F39 Mood [affective] disorders
  • F40-F48 Neurotic, stress-related and somatoform disorders
We find PTSD in the latter group. There are many shades in that group, shades that sometimes blend into each other, and for the sake of argument we can say PTSD is blood red and DPDR (F48.1) is crimson red. They're different, they're similar. In DPDR (F48.1) the fight-flight-FREEZE response has gone haywire. In PTSD the FIGHT-FLIGHT-freeze response has gone haywire. Simply put. But it's never simple.

Why would it matter, if DPDR (F48.1) and PTSD are closely related? Well. The former diagnosis is never given, almost. There are twelve study articles on it last year, there are 2,559 new study articles on PTSD. For the former diagnosis it's all doors closed, no real treatment options, no hope in sight. For PTSD there's a wellspring of treatment options, in comparison. They say 1–2% of the general population have depersonalization-derealization disorder at a given time. That's a lot of people. Let's say BLT helps, let's say regular EMDR helps, let's say novel PTSD therapies help, let's say ... Looking at it from a distance, it seems they're close siblings, the frozen F48.1 and the fight-flight PTSD. Both are FFF reactions.

When it comes to management, something that complicates treatment of F48.1 is that there aren't like a single episode of trauma that juts out and you can tackle, but often in F48.1 it's traumatizing emotional stress over a prolonged period of time, before the permafrost of fight-flight-freeze comes.

Anyways. That's my loose thoughts on this: it would stand to reason to lump them together as «FFF disorders», and the lines between those FFF disorders can be blurry.

Your thoughts?

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joeylittle

Administrator
@Gibson - I've removed your links because they were to search pages. I'm posting this info so people don't go after the OP for a lack of citation. If you want to link, please be more specific. If you have more questions about that, ask them via Contact Us.

That being said - much of what you're saying doesn't make a ton of sense, to me. The diagnostic codes you are referencing, they are ICD-10, yes?

In DPDR (F48.1) the fight-flight-FREEZE response has gone haywire. In PTSD the FIGHT-FLIGHT-freeze response has gone haywire. Simply put. But it's never simple.
Where are you getting this info from?
 
Are you asking if PTSD exists at all?

Look, PTSD as a diagnosis is a name given to a set of symptomatic criteria caused by a set of specific traumas. The symptoms certainly exist, as do the traumatic stressors that are the precursor to the symptoms. The functionality of the brain is observably different between someone with PTSD and someone without PTSD. So I'd say that it exists.

Are there other diagnoses that share the same symptoms? Certainly. But the diagnosis of PTSD comes with a specific set of symptoms caused by an actual injury to the way the brain works, caused by one or more incidences of traumatic stress.

The criteria between the ICD and DSM differ slightly. But everyone agrees that PTSD is real and is its own neurological syndrome as opposed to other disorders.

It might help you to learn the history of PTSD, how it was called shell shock and war neurosis in veterans, and how the medical establishment realized they were seeing the exact same set of symptoms in non-veterans who had gone through traumatic events. There's lots of stuff online.
 

Gibson

Policy Enforcement
Phew. Done writing. Here I've tried to clarify my points, leading to the conclusion that there is a close kinship between what I call «FFF disorders» (fight-flight-freeze disorders), and often even blurry lines and a continuum, which is the central thesis of this thread.

Do feel free to disagree with any of the bullet points below, @somerandomguy and @joeylittle.

1a) A general point. In organic diseases a blood sample may say negative/positive, whereas in mental disorders you are left with more uncertainty.

1b) The lines between psychiatric disorders are sometimes clear, such as between OCD and autism. They've got different etiology, and are as different as ROYGBIV. But sometimes the lines are fuzzy such as between dysthymia and depression. Between such diagnosis we've drawn an arbitrary line. Such an arbitrary line has value, sure. And here's where the rainbow metaphor comes in. We have names such as «ocean blue» and «azure blue», and we have names such as «dysthymia» and «depression», names we have given to two different boxes, and it's valuable to look at them as discrete, but we also know they are uncertain sets with fuzzy lines, that is: those who «are blue» (I had to select a color, don't read too much into the chosen) have elements from both boxes and there's a gradient between them. That is: there's an overlap in etiology, overlap in symptoms, and even though we've put them in boxes we know there's really a gradient.

1c) There is an overlap in etiology also between PTSD, C-PTSD and DPDR (F48.1)
Guess which of the disorders may arise after:
Severe trauma, during childhood or as an adult, such as experiencing or witnessing a traumatic event or abuse. And you can recover by going to therapy and dealing with the triggers. I am not saying the etiology and the symptoms of PTSD, C-PTSD and DPDR (48.1) are indistinguishable, they aren't. I am saying the overlap is large, in both etiology and symptoms, and this is a soft science where many questions still are left unanswered. Thankfully I might add, since we don't have the best treatment options yet, a better understanding may give us better treatments, generally speaking. Since you asked, it's in the ICD-10 (which is referenced in this thread) that DPDR and PTSD are put in the same group. But the number codes referenced in this thread aren't central to the argument.

2a) In PTSD the fight-flight system has gone haywire. If this statement is debatable, let me know.

2b) My model of PTSD is that the fight-flight response has gone into overdrive, and is now easily triggered and/or jammed, causing constant alert. Anger reactions may resemble fight-reactions, anxiety may be the flight-reaction kicking in. Flashbacks can make the initial fight-flight reaction kick in again. I know, I know. I am leaving much out. It's a crude model. But nevermind what's left out. If you disagree with the gist of it, the statements about fight-flight and anger-anxiety, please let me know.

This is a digression, and to you guys this is prolly pointing out the bleeding obvious. But it's interesting to note that functional MRI studies have shown that PTSD patients have an exaggerated amygdala response to emotional stimuli when compared to controls, as it's the amygdala which is the primary structure of the brain responsible for fight or flight responses.

2c) Animals have three responses to threat: Fight, flight, or freeze (i.e. "play dead")

2d) The initial trauma of PTSD may engender a freeze reaction, instead of fight-flight.

«Despite evidence suggesting that tonic immobility may be a key facet of alarm reactions, freezing has received relatively little scientific attention in humans. One exception is the PTSD/rape literature wherein several studies have described a rape-induced paralysis (...)» That's a frozen reaction.

2e) The amygdala plays a key role in freezing behavior, as well as fight-flight.

2f) The depersonalization-derealization disorder may be seen as primarily freezing, instead of fight-flight.

I guess it's this statement you primarily feel needs underpinning?
 
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Except ... "fight-flight-freeze" as a set of reactions actually has zero neurological value. It's a term that wasn't even coined by a neurologist. It's shorthand, used by laypeople, to explain a much more complicated set of actions and reactions that take place in the brain and limbic and nervous systems.

So I'd say your theory has low to no merit.
 

Gibson

Policy Enforcement
Are you asking if PTSD exists at all?

Look, PTSD as a diagnosis is a name given to a set of symptomatic criteria caused by a set of specific traumas. The symptoms certainly exist, as do the traumatic stressors that are the precursor to the symptoms. The functionality of the brain is observably different between someone with PTSD and someone without PTSD. So I'd say that it exists.

Are there other diagnoses that share the same symptoms? Certainly. But the diagnosis of PTSD comes with a specific set of symptoms caused by an actual injury to the way the brain works, caused by one or more incidences of traumatic stress.

The criteria between the ICD and DSM differ slightly. But everyone agrees that PTSD is real and is its own neurological syndrome as opposed to other disorders.

Amen. I agree. And thanks for asking politely as my initial post was rather cluttered.

It might help you to learn the history of PTSD, how it was called shell shock and war neurosis in veterans, and how the medical establishment realized they were seeing the exact same set of symptoms in non-veterans who had gone through traumatic events.

Yes. And this is key to understanding not only PTSD, but psychiatry as a whole. It's a new field. Definitions change. Usually for the better. And thus the understanding becomes more complete. From the days of Freud to shell shock and today, much has happened. Regretfully I used to think PTSD was something only for vets, but we all know that definition is as narrow as it is wrong. I really find it useful to look back at how things actually have changed, as that tells we've got a winding path ahead of us as well. Definitions we have today will change in the future.
 

Sideways

Moderator
there is a close kinship between what I call «FFF disorders» (fight-flight-freeze disorders), and often even blurry lines and a continuum,
Sorry, not a scientist, but I seem to be missing the point you're making.

Is there anything actually new here? You're coining the phrase "FFF disorders", but aside from that term, everything you've written about trauma responses and the related mental health disorders overlapping...isn't that all kinda stuff that we've known for quite a long time?

Like, the window of tolerance model, what we know about the sympathetic and parasympathetic nervous system responses...none of that is particularly new...*scratch head*.

What am I missing?? I mean, even before we had functional MRIs, we had old school MRIs that showed abnormal amygdala growth, and in the hippocampus too I think (in that case, stunted development in prolonged childhood trauma cases).

There's also the Flop response, which is at the Freeze end of the spectrum. That one really sux (from personal experience!). But...it's not exactly new knowledge...
 

Freddyt

Confident
This is a digression, and to you guys this is prolly pointing out the bleeding obvious. But it's interesting to note that functional MRI studies have shown that PTSD patients have an exaggerated amygdala response to emotional stimuli when compared to controls, as it's the amygdala which is the primary structure of the brain responsible for fight or flight responses.
Because in the mature human brain amygdala is a secondary response, not a primary response, in people with PTSD it is a primary response.

If you want a diagnoses, please see a professional.
 

DharmaGirl

MyPTSD Pro
There is an overlap in etiology also between PTSD, C-PTSD
That is because the word Complex in Complex PTSD is a definer. You must first satisfy the criteria for PTSD to have Complex PTSD.
And you can recover by going to therapy and dealing with the triggers.
I don't agree. You can manage the symptoms by dealing with the trauma itself, and learn how to handle triggers, but I don't know that one can recover.
 

Gibson

Policy Enforcement
Sorry, not a scientist, but I seem to be missing the point you're making.

Is there anything actually new here? You're coining the phrase "FFF disorders", but aside from that term, everything you've written about trauma responses and the related mental health disorders overlapping...isn't that all kinda stuff that we've known for quite a long time?

Like, the window of tolerance model, what we know about the sympathetic and parasympathetic nervous system responses...none of that is particularly new...*scratch head*.

What am I missing?? I mean, even before we had functional MRIs, we had old school MRIs that showed abnormal amygdala growth, and in the hippocampus too I think (in that case, stunted development in prolonged childhood trauma cases).

This was encouraging, that you feel the thread's central points are pretty much established knowledge, along with the new umbrella term «FFF disorders», which you feel can be justified. It's what I was aiming for. To show and build arguments for why lumping together PTSD, C-PTSD and DPDR makes sense, acknowledging there are differences, but also overlaps and blurry lines.

Why is this important? Those who get the FFF diagnosis DPDR F48.1 doesn't have access to the same therapy toolbox that PTSD and C-PTSD patients have. It's not because there's ill will or a heated argument against lumping them. It's because there are no research units working on DPDR F48.1 anymore, hence there's isn't any progress on ways of handling or looking at the disorder. There used to be one (!) research unit in King's College working it this, but they ran out of funding and now they're defunct. Now the world's got zilch.

Why isn't there research money? The diagnosis F48.1 hasn't grown out of fashion, it simply never caught on. It's only a few psychiatrists using the diagnosis, and thus fewer doing research on it. There's so few people on it, I'd say you could fit all the world's full-time F48.1 researchers into a minibus.

Why isn't the diagnosis F48.1 more used? People who have symptoms of DPDR F48.1 usually have much stronger elements from other psychiatric disorders, so they get those diagnosis instead, and the whiff of DPDR is just seen as an aspect of that disorder, and treating the underlying disorder makes DPDR the better.

There's also the Flop response, which is at the Freeze end of the spectrum. That one really sux (from personal experience!). But...it's not exactly new knowledge...

Now this was interesting, gold really, so thanks for sharing, and sorry you've had it so bad. I didn't know such extreme freeze reactions could be part of such disorders. I hope such freezing is rare or absent with you now!

Blurred lines are nothing new, you say, and I appreciate that. I'd like to think of the FFF diagnosis as three mountains in a mountain rage. They're connected, they're separate. And each patient has his or her own topography. Sometimes they have a peak at say C-PTSD, that is: they have a very good fit on such symptoms and etiology, but also elements from say PTSD, DPDR and depression.

If someone has an illness released by severe trauma, and a topography with strong elements from the freezing peak of DPDR F48.1 but weaker from regular PTSD and C-PTSD, they're in trouble, as the DPDR F48.1 diagnosis is a dead end, really.
 

Survivor3

MyPTSD Pro
Do you suffer from ptsd? Have you suffered from life threatening trauma or sexual abuse? Are you under professional care of a therapist or doctor?
 
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