Lets Create A Ptsd Diagnosis

[anthony]

Fictitious is good... so if the above is such, then the above still applies. Different criterion apply to different aspects, but you also certainly will not cover every possible scenario within one diagnosis.

I was pointing out that IF you use your personal circumstance, which to me it sounded that way when you use "I", I assume it is about you, then nothing good has come so far from people doing so. People have been attempting to fit their issues into the diagnosis, and so far its done nothing.

Fictitious is good though, thanks.

 

[anthony]

Ok, C is locked in. Lets go at D:

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “no one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

 

[anthony]

I have two changes that I would like to request:

1. Somatisation needs to be added. Defined: the manifestation of psychological distress by the presentation of bodily symptoms.
2. If it is added, then the requirement need be changed to 4 instead of 2. If not, then 3 instead of 2.

Does somatization fit correctly? Or does it need go elsewhere IF included?

Based on most current PTSD research, somatisation is huge aspect of PTSD, however; it is psychological distress based on bodily symptoms, which are caused by internal or external factors. A little bit of a merry-go-round scenario, yet a majority seem to endure somatisation with PTSD.

You become anxious and begin sweating, is one example. You then become more anxious, hide yourself, avoid people further (exacerbation of symptoms) based on a retraumatization process in essence, yet all based on PTSD symptoms themselves.

 

[EveHarrington]

Fully agree with addition of somatization criteria. Not sure if this is the right place though. Will have to think about it. But now that I think about it, I'm surprised it hasn't been added earlier. I think PTSD diagnosis needs to move out of the primary mental realm into a dual physical/mental realm. Yes it is going in that direction, but IMHO not fast enough. This criterion will help. Maybe I'm not fully articulating? My apologies.

 

[joeylittle]

somatisation is huge aspect of PTSD, however; it is psychological distress based on bodily symptoms, which are caused by internal or external factors.

I read somatization differently - that it is psychological distress manifesting as physical symptoms

Somatization is the expression of mental phenomena as physical (somatic) symptoms. Disorders characterized by somatization extend in a continuum from those in which symptoms develop unconsciously and nonvolitionally to those in which symptoms develop consciously and volitionally. This continuum includes somatic symptom and related disorders, factitious disorders, and malingering. In all of the disorders, patients focus prominently on somatic concerns. Thus, somatization typically leads patients to seek medical evaluation and treatment rather than psychiatric care.

Taken from The Merck Manual, professional version, Overview of Somatization

So, the end result is not a mental symptom, but a physical one.

It is different from a flashback, in that the physical is not caused by a memory; it's only caused by a feeling. It's having a physical association with something in your mind, and I think with PTSD it would want to be on the unconscious and non-volitional end of the spectrum (as opposed to the conscious and volitional end, which is where we find factitious disorder, malingering, etc.)

I think the classic example is, I am anxious about a test I am taking later, and I have a stomach-ache. I don't have the pain because I didn't eat as a result of being nervous, or because I'm tired because I was up all night studying - there is no physical reason why I have the ache, it is purely a result of my feeling of anxiety.

I believe the 'heavy limb' phenomenon associated with depression would be a form of somatization, as well.

So, no physiological reason, including the body 'remembering' pain from the past. And that's where I get a little confused, because I used to think that those kinds of pains could be called somatic, but reading through this (and other) psych texts on somatization, somatoform disorder, etc...it seems like no, it needs to be mental phenomena creating physical symptoms.

?

 

[Sideways]

D7: reads as anhedonia. I like plain english, but if we mean anhedonia, I think it's ok to say that - we're using other phrases like "dissociation", and "anhedonia" would be on a similar level?

 

[anthony]

So, the end result is not a mental symptom, but a physical one.

One manual uses mental phonemena and dictionary uses psychological distress, yet they're both saying mental causes physical.

So, are you saying it should not be included in D based on being affect and mood symptoms versus say E which are arousal symptoms (physical outcomes of mental x)?

 

[anthony]

D7: reads as anhedonia.

That was used in an earlier version... they removed that word and instead expanded it in simple speak for some reason.

 

[joeylittle]

versus say E which are arousal symptoms (physical outcomes of mental x)?

Correct. That in purely medical terms, somatization is mental phenomena expressed as physical ailment, that cannot be ascribed to any other logical/medical source.

And I do think it goes into the arousal category, exactly for the reason you stated.

 

[anthony]

Makes sense to me actually, go for E instead.

So then... really zero changes as this does otherwise make sense:

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by three (or more) of the following:

1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “no one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

 

[joeylittle]

@anthony - numbers 4 and 7 are really reflections of each other, and given that one only need three of these (and in the interest of streamlining), I wonder if 4. could become:

4. Persistent inability to experience positive emotions (e.g., happiness, satisfaction, love), and/or persistent negative emotional state (e.g. fear, anger, guilt, shame).

• Edited the second occurrence of 'inability to experience' in the parenthetical positives.
• Replaced 'loving feelings' with 'love'; feelings is redundant in context.
• Used and/or to allow for one and not the other (which was the only advantage of having them separated).
• Edited 'horror', as it is redundant to 'fear' - since these are examples only, they need not have such fine distinction, I don't think.

Without combining these, it would be possible for someone to have criteria 4, then criteria 7 almost by default, and likely number 5 since it is closest to 4 and 7. It strikes me as too easy to hit 3, but that none should be cut.

 

[anthony]

D4 - Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
D7 - Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

I get what you're saying, as they are closely linked. The additional text on these in the DSM are:

D4 - A persistent negative mood state (fear, horror, anger, guilt, shame) either began or worsened after exposure to the event.
D7 - A persistent inability to feel positive emotions (especially happiness, joy, satisfaction, or emotions associated with intimacy, tenderness, and sexuality).

D4 is a mood state and D7 a cognitive one.

D7 is really anhedonia: inability to feel pleasure in normally pleasurable activities - Maybe should simply be called this instead of confusing between mood state and emotional state? Maybe even just use the definition of anhedonia to keep it simple as is, yet correctly reflect with more accuracy?

However... many men with PTSD love sex, yet they don't actually feel positive emotion about the intimacy or person, more just the act of sex itself. Maybe this is why they shifted away from the subtle anhedonia term?

Interesting... as D cluster is cognitive and mood, but not sure a cognitive and mood should be mixed together or not, even with and/or for singular or dual use.