Lets Create A Ptsd Diagnosis

[joeylittle]

Somatization, the manifestation of psychological distress by the presentation of bodily symptoms related to the trauma.

I'm sorry to be the pain in the ass here - but this reads purely as being upset by actual physical symptoms. In other words - if I was in a car crash and lost the use of my left arm, it would be somatization if I were to be distressed by the bodily symptom, AKA the lost use of the arm.

Somatization, in this example would be more like phantom pain in the limb, or even neck, or shoulder, or back pain.

That's not quite a perfect example, but hopefully, you can see the problem.

In pure medical terms, something cannot be somatic pain unless it has no other identifiable cause - that's what makes it a manifestation of 'brain pain'.

So, perhaps
Somatization, expressed as physical pain with concurrent psychological distress, where the physical pain has no other identifiable cause and the psychological distress relates directly to the pain being experienced.

I know that's a totally different sentence.

I can annotate through it. It's in it's longest form.

 

[anthony]

Whilst I agree, I also don't think somatization should be defined when being written as a symptom. Diagnostic symptoms are not meant to read as definitions, but instead of the manifestation itself is the focus.

I think that needs to come right down to the bare basics.

I also think pain should not be used, because somatisation does not have to include pain.

• the unconscious rechannelling of repressed emotions into somatic symptoms as a form of symbolic communication.
  
• More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety.
• Such symptoms cannot be fully explained by a general medical condition or substance use OR, when there is an associated medical condition, the impairments due to the somatic symptoms are more severe than generally expected.

Maybe more along the lines of: Somatization, the manifestation of bodily symptoms not attributed to a medical condition or substance use.

Medical condition removes things like amputation or such, which are medical based and have known phantom pain or such.

Something to ponder upon here, is that we also have criterion H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Does this cover everything automatically without having to repeat oneself symptom by symptom?

https://www.myptsd.com/threads/ptsd-diagnosis.87466/

To me this makes sense why this isn't mentioned elsewhere, as H carries the single weight of application.

 

[Sideways]

Somatization, the manifestation of bodily symptoms not attributed to a medical condition or substance use.

This does seem to be just defining what somatization is...and the "related to the trauma" part is gone - is that intentional?

 

[Sideways]

Would something like "Somatization relatable to the traumatic event(s)" be too simplistic?

 

[anthony]

If criterion H stands to adequately cover that all facets are not attributable to medical conditions, alcohol or drug use, then I think the shortened version is a better fit.

Sorry, I do concur that trauma should be there, or the event/s, as diagnostic criterion must refer to a consequence of the event's and not something unrelated.

 

[joeylittle]

I found this useful:
http://www.dsm5.org/documents/somatic symptom disorder fact sheet.pdf
And this excerpt in particular:

While DSM-IV was organized centrally around the concept of medically unexplained symptoms, DSM-5 criteria instead emphasize the degree to which a patient’s thoughts, feelings and behaviors about their somatic symptoms are disproportionate or excessive. The new narrative text for SSD notes that some patients with physical conditions such as heart disease or cancer will indeed experience disproportionate and excessive thoughts, feelings, and behaviors related to their illness...In this sense, SSD is like depression; it can occur in the context of a serious medical illness.

...somatic symptoms must be significantly distressing or disruptive to daily life and must be accompanied by excessive thoughts, feelings, or behaviors.

Totally agreed, my proposal veered off in the direction of definition; also, that criterion H stands in for any reference to other diagnoses. I think this is what comes from trying to think nuanced thoughts while having quite a lot of Criterion E going on in my own life right now :O_o:.

I'm also not suggesting that point 7 needs to mirror the whole of the criteria for Somatic Symptom Disorder - but, it's interesting to note that elements of it can nest inside of PTSD, the same way they suggest (above) that it can nest inside straight-up medical conditions.

Somatization relating to the traumatic event(s), marked by significant distress or disruption to daily life.

Long, again. But maybe on the right track?

I will, though, defer to the thoughts of others on this. I think I just burst a few brain cells coming up with a barely-working sentence, there, and don't want to hold up the process with my own squirmy thoughts about articulating this issue. The biggest argument in favor of the suggestion above would be that it mirrors language already existing in somatic symptom disorder. It also feels important to be clear that it is at a clinically significant level. It's one thing to think on something and remember it with a twinge. It's another to think on something and be rewarded with a blast of pain. You know?

 

[oasis2003]

Well after looking at the link about SSD I also feel that this can be encompassed In PTSD diagnosis. I am glad they got rid of hypochondria aspect, there is no way that peoples somatic symptoms are made up. It is good that they are looking at the whole body and mind approach and that they are intrinsically linked rather than treating them separately. I think that if a significant proportion of people with somatic symptoms give pain when thinking about the trauma, or an emotional response automatically lead to pain related to the trauma then it should be added to the narrative. If however only a small proportion of people have pain during their somatic symptoms then it could be omitted. Perhaps a poll needs to be carried out. Perhaps people with medical, sexual abuse, military and any trauma causing physical harm may be prone to painful somatic symptoms. PTSD needs a somatisation subsection added though as well as the SSD diagnosis. Where it disrupts daily life and creates avoidance of thinking of the traumatic event. On the positive I was pleased to read that now PTSD is treatable and there is a list of treatments to pursue.

 

[oasis2003]

the unconscious rechannelling of repressed emotions into somatic symptoms as a form of symbolic communication.

This also seems to cover repressed pain which manifests itself as somatic symptoms so I see what you mean about not having to mention pain specifically.
I also read the link in article archives and it covers everything rather than listing symptoms and repeating.
The addition of not being related to other medical conditions etc discounts phantom pains.
The thing that gets me is people could be diagnosed with PTSD and also dissociative disorder and general anxiety disorder and SSD , when one diagnosis of PTSD could do all if it was nailed properly.
It is so good that cPTSD is going to be identified in 2017 there is no way that a single criterion A trauma which caused PTSD, can be compared to ongoing trauma and damaged belief systems that cPTSD can cause and that the abuse seems natural and the norm. I am not disputing that they are just as traumatic as the other but surely the treatment , medications and symptoms will be totally different and that they both cannot be encompassed in PTSD but a separate category as cPTSD and PTSD.

 

[anthony]

I would agree that that is a better version:

So at present, we then have cluster E as reading:

E. Marked alterations in arousal and reactivity 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. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance, expressed as heightened sensitivity to potential threats (e.g., fear of motor vehicles following an accident), whether related or unrelated to the traumatic event (e.g., fear of sudden shock causing a heart attack).
4. Exaggerated startle response.
5. Problems with concentration, such as difficulty remembering daily events or attending to focused tasks (e.g., reading, conversing)
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
7. Somatization relating to the traumatic event(s), marked by significant distress or disruption to daily life.

Issues, clarity, changes, solutions?

 

[anthony]

Ok then, E is locked in. Here we go, the real fun part of the exercise. I have now added the remainder criterion here, as they're minor aspects now, yet have major relevance into how we create the new F cluster for regulation that is optional for complex diagnosis. I have renamed the remainder to accurately reflect the desired outcome. I think the sub-types are going to tie into cluster F here at points, as they're also optional components.

F. see below.

G. Duration of disturbance (Criteria B, C, D, and E) is more than 1 month.

H. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

I. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Specifiy whether:

With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:

1. Depersonalization: Persistent or recurrent experiences of unreality of surroundings (e.g., feeling as though one werre in a dream; feeling a sense of unreality of self or body or of time moving slowly).
2. Derealization: Persistent or recurent 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, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

 

[anthony]

Now, I guess there is one of two ways to do this... we add cluster F and create regulation symptoms (which I think is needed to fully classify complex) or we leave F, G, H as they were and we create a complex sub-type containing an outline of the regulation problems.

What is the best method?

Looking at my prior thoughts on this, I had roughed out a quick list and also the main offender symptoms to be viewed for regulation issues in complex sufferers.

F. Regulation symptoms (3 or more diagnose complex):

1. Chronic fear of abandonment and trust.
2. Inability to regulate feelings of guilt or shame.
3. Recurrent suicidal behavior, self-mutilation or threats off.
4. Severe dissociative / depersonalization episodes.
5. Inability to regulate self-destructive behavior.
6. Perception of the perpetrator, including incorporation of his or her belief system.

Symptom List

upsetting memories
flashbacks
nightmares
distress
intense physical reactions when reminded of the event (sweating, pounding heart, nausea)
avoid activities, places or thoughts
feel detached from others
emotionally numb
lose interest in activities and life in general
sensing only a limited future for yourself
trouble sleeping
irritability or outbursts of anger
difficulty concentrating
feeling jumpy and easily startled
hypervigilance (on constant “red alert”).
Guilt, shame, or self-blame
Feelings of mistrust and betrayal
Depression and hopelessness
Suicidal thoughts and feelings
Physical aches and pains

#4 just looking at it, probably needs to reflect more accurately to regulation due to the specify with sub-types of dissociative symptoms. Or we get rid of dissociative symptom sub-types and include them in the primary clusters?

 

[anthony]

And maybe for consideration in all this, is the new cPTSD ICD criterion additions that are being tested, and thus far, approved for the diagnosis... if they do not befit already with existing DSM criteria, noting that these are worked against the ICD PTSD version, which is not similar to the DSM.

Affect dysregulation (Temper outbursts that you could not control, Your feelings easily hurt)
Negative self-concept (Feelings of worthlessness, Feelings of guilt)
Interpersonal problems (Never feeling close to another person, Feeling distant or cut off from other people)