Well I don't have complex ptsd then.
Having a bad day. I'm gonna take myself off for a bit.
Having a bad day. I'm gonna take myself off for a bit.
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.
That is because you have the complex version of PTSD. You wouldn't have them both. If you break your leg in two places you don't have a fracture and a compound fracture, you just have a compound fracture. They are 2 different diagnoses, but you have to satisfy the criteria for a fracture to have a compound fracture.
"The criteria for CPTSD are the same as those for PTSD, but with the addition of disturbances in self-organization". from: ICD-10 versus ICD-11: the effects of PTSD diagnoses - ACAMH
The ICD-11 formulation of PTSD requires exposure to a trauma defined as an extremely threatening or horrific event or series of events. Similar to the original DSM version of PTSD, the disorder includes three core elements or clusters: re-experiencing of the traumatic event in the present, avoidance of traumatic reminders and a sense of current threat. This formulation conceptualises PTSD primarily as a conditioned fear response and the re-experiencing and avoidance symptoms are specifically tied to the traumatic event. CPTSD includes the three core elements of PTSD as well as three additional elements called disturbances in self-organisation that are pervasive and occur across various contexts: emotion regulation difficulties (for example problems calming down), negative self-concept (for example beliefs about self as worthless or a failure) and relationship difficulties (for example avoidance of relationships)
This is from:
ICD-11 complex post-traumatic stress disorder: simplifying diagnosis in trauma populations | The British Journal of Psychiatry | Cambridge CoreICD-11 complex post-traumatic stress disorder: simplifying diagnosis in trauma populations - Volume 216 Issue 3www.cambridge.org
Complex post traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). All diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterised by severe and persistent 1) problems in affect regulation; 2) beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and 3) difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
ICD-11 MMS code 6B41 Complex post traumatic stress disorder with excludes, code elsewhere, and included sections/codes.www.findacode.com
I hope that clears up what I was saying. I quoted so many sources because I wanted to make sure I read it right.
I used to qualify as having ptsd. Not anymore.
Know you probably won’t read this for awhile... and by the time you do, you’ll probably already grok this. But? At least for clarity’s sake...Well I don't have complex ptsd then.
Putting aside Wikipedia and the NHS for a moment, if you're interested, head to Judith Herman's 1993 Trauma & Recovery, where the concept of Complex PTSD originated. She lays out her reasoning for both why she thought it should be distinguished from PTSD, and her proposed diagnostic criteria.I think the definition of C-PTSD as laid out on the English Wikipedia page is useful,
PTSD + Prolonged & Complex = CPTSD ((-or- PTSD w/ complex trauma))
You can’t have CPTSD, without first having PTSD.
Looooooove the fracture analogy, by the by.
This might help some people out. It’s a bit of an older article, with the ICD-11 still in draft form, but the Dx Criteria hasn’t changed from the draft form.
Understand Complex PTSD (CPTSD)
For more visually minded
In ICD-11, the description of complex trauma is as follows: “Complex post-traumatic stress disorder” (Complex PTSD) is a disorder that may develop following (...). The diagnosis requires an event or series of events of an extremely threatening or horrific nature, where the possibility of escape is difficult or impossible. In our clinical encounters, targets of bullying have described that they thought they were going to die. As for the accompanying overwhelming emotions to intrusive memories such as fear or horror, we expect that reactions can become blunted when targets suppress, blunt, or dissociate over time to escape the emotional pain involved. Memories and associated emotions change over time and individual adaptations take place to accommodate and dampen them. We argue that studies on bullying confirm the subjective experience of this as extremely threatening and that the narrowing or widening of the stressor criterion [Criterion A, see (4)] would make little difference as to whether bullying is a stress related disorder. (source)
Traumatic reactions occur when action is of no avail. When neither resistance nor escape is possible, the human system of self-defense be-comes overwhelmed and disorganized. Each component of the ordinary response to danger, having lost its utility, tends to persist in an altered and exaggerated state long after the actual danger is over. Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory. Moreover, traumatic events may sever these normally integrated functions from one another. The traumatized person may experience intense emotion but without clear memory of the event, or may remember everything in detail but without emotion.
Mental health professionals who specialise in trauma should be able to identify when there is (1) mental health disorder from trauma (say, PTSD or Anxiety or Adjustment Disorder) in addition to (2) a dissociative disorder.
With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and the individual experiences persistent or recurrent symptoms of either of the following:
1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body
or of time moving slowly).
2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts) or another medical condition (e.g., complex partial seizures).
With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Two of the reasons people tend not to present and get a dissociative disorder diagnosis on its own, or before they get diagnosed with anything else? Is dissociation on its own is such a normal part of the daily human existence. Mentally healthy people dissociate (day-dreaming, auto-pilot when they're driving etc) every day of the week.
Dissociation isn't well understood
I don't think that it's necessarily as easy as simply viewing the various forms of dissociation as different types of your FFF responses. While we understand that dissociation can be a coping mechanism for stressful situations, we don't know if depersonalisation, for example, is the same thing going on physiologically as the freeze response. My experience of derealisation in the past doesn't line up well with the window of tolerance model that you'd use for FFF responses, and my experience of switching between alters (DID) very definitely doesn't.
What seems more likely, and I think is the current general understanding, is that you have 2 very different things going on, sometimes occurring at the same time, sometimes not.
(1) The FFF response, which is your sympathetic/parasympathetic nervous system spectrum of physiological responses; and
(2) Dissociative responses, which is a spectrum of its own, and where depersonalisation and derealisation are further up the curve than ordinary daydreaming, and DID sits at the very end of the spectrum (is how they seem to theorise it - you're right that we don't really understand dissociation that well).
Not an arbitrary line; a very well defined one, actually. Please don't talk to me about it, those are my diagnoses.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.
All brain science is soft science.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
It's like you've thought about this stuff and think you've come up with something novel...without understanding that the relationship of the amygdala to the fear response to PTSD is one of the better-understood aspects of the disorder.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.
Yes. That's a solid bit of data.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.
And, since this isn't really neurology - it's a physiological concept from the 1920's - we should throw in the fourth recognized response - "fawn".Fight, flight, or freeze (i.e. "play dead")
Yes - that's not really "relatively little scientific attention".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.
Personally - no. There is much more logic behind classifying PTSD as it is in the DSM 5 - "trauma or stressor related disorders" - or the ICD 10, "neurotic, stress-related, or somataform"along with the new umbrella term «FFF disorders», which you feel can be justified
Indeed.And you could certainly question the utility for the new phrase I proposed.
(nice little article)Now, data from a study recently published in the Journal of Child Psychology and Psychiatry have shed light on the clinical utility of these revisions in the ICD-11. “Initial conceptualisations of CPTSD suggested it was most likely to occur as a response to repeated or severe trauma histories; as such, CPTSD won’t be commonly assessed following a single traumatic event”, explains corresponding author Dr Caitlin Hitchcock. “We felt that it was important to explore whether rates of CPTSD are indeed low in young people exposed to a single traumatic event, as the ICD-11 diagnostic criteria don’t actually list repeated trauma as being necessary for a CPTSD diagnosis”.
No, no, no, no. Fight, Flight or Freeze - these things don't cause PTSD.But regardless of that, we do know that FFF responses may cause PTSD, PTSD w/ DPDR subtype, or DPDR. And you could certainly question the utility for the new phrase I proposed.
This is what the ICD-11 thinks:When I read on C-PTSD in ICD-11, I am left with the impression it's defined such that you need at least a single extreme event that sent it cascading, and chronic trauma would simply not suffice.
What do you guys think?
-World Journal of Psychiatry, 2018 paper on CPTSDAccording to ICD-11, complex PTSD follows exposure to a traumatic event or a series of events of an extremely threatening nature most commonly prolonged, or repetitive and from which escape is usually impossible or strenuous...
Yup, so Google Scholar the hell outta itI'd be interested to know whether there are studies on the amygdala and actual DPDR
Phrasing like this ^^^ is likely gonna cause friction round here!! Just sayin!What makes me curious is that freezing and fight-flight both seem to be related to a «jammed amygdala»
That is because the word Complex in Complex PTSD is a definer. You must first satisfy the criteria for PTSD to have Complex PTSD.