Lets Create A Ptsd Diagnosis

[lostforgottensoul]

This is where I keep getting stuck, thrashing things out in my own mind. LOTS of things are traumatic enough, or disturbing enough, to create issues. A wide variety of them. But not traumatic enough for PTSD.

I can give examples if that helps to close the gap but by itself i think it would have caused PTSD.

I mean i dunno if they would of as its not the only thing that happened but thinking of just that, i think it would of. But other things were involved, sexual abuse, emotional abuse etc so i dont have a way to gauge it other than it was horrible images and videos and happened over many yrs.

Say a child had to view pictures of dead bodies, videos of murders, etc over about 9 yrs. It happens, happened...so i think that in itself would suffice for PTSD by itself, even if rare, it happens and if its by itself that person at the moment wouldnt qualify for PTSD. Or thats how im understanding it.

 

[joeylittle]

a child forced exposure to such torment, yet not otherwise abused physically, sexually or such, is then left open.

This is where I have issues with the images vs. being present thing. An image has a separation factor that significantly alters how it is perceived. I don't mean just trauma, I mean anything.

Is it possible for anyone - child, or anyone - to be traumatized by repeated viewing of images of death, sexual violence, or catastrophic injury, if they have no other direct experience with those things? Traumatized enough to cause PTSD, specifically? I don't know that's true. Is there evidence for this?

What about the child who seeks out those images willingly, and is not exposed to trauma in any other way? Would that be sufficient to trigger PTSD?

Saying that it is work-related implies two things: one, that on a certain level you can't just not look at the stuff; and two, that it is in the fabric of your daily life.

Because - as @FridayJones said earlier - the trauma that caused PTSD is not the same always as the thing that sets it off, if it does not happen immediately. And you don't get more than one diagnosis of PTSD. So, I don't need to make a case for how everything that happened to me, taken one thing at a time, will all qualify for the diagnosis. Just one thing needs to qualify.

 

[lostforgottensoul]

@joeylittle not arguing, asking, would this one thing, where it was forced and couldnt look away and was prolonged, would that not qualify for possible PTSD later in life?

Say a child had to view pictures of dead bodies, videos of murders, etc over about 9 yrs. It happens, happened...so i think that in itself would suffice for PTSD by itself, even if rare, it happens and if its by itself that person at the moment wouldnt qualify for PTSD. Or thats how im understanding it.

Edited to add: just one example but likely the worst.

 

[joeylittle]

where it was forced and couldnt look away and was prolonged,

I think in order to create the conditions where it was forced, prolonged, and the child couldn't look away - there would need to be some kind of threat of violence or actual violence involved against the child, which would make the violence the main issue, and the images secondary, as far as PTSD is concerned.

ETA: just by virtue of the fact that we are using the word 'forced' - to me, signals that the other criteria are being addressed. There is significantly more research pointing towards desensitization in children re: moving images, than to traumatization.

 

[lostforgottensoul]

@joeylittle i see what you're saying and yes thats true...so the violence is already in the listed items...so that would make it qualify anyway.

 

[Deleted member 28740]

Would that be sufficient to trigger PTSD?

And the dilemma is why some get PTSD from an event and others don't. Why it is so hard to define the criteria, trauma resulting in PTSD is not universal in similar event causality. Siblings in one household with Criteria A do not all result in a diagnosis, based on environment or events.

 

[lostforgottensoul]

A. Exposure to actual or immediate threat of death, catastrophic injury, or sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s),
2. Witnessing, in person, the event(s) immediately as it occurred to others,

(Does not apply to exposure to electronic media, television, movies, or pictures, unless the exposure is work related for a period of longevity.)

Is this what its compiled to, since 3 & 4 were scratched & all decided the media doesnt apply unless work related?

Asking just to sorta put it all together and understand is all.

And note: I love how much easier this is to understand as what it started as i was **head scratch**

 

[anthony]

Streamlining shouldn't disinclude legitimate cause.

That is why I initially suggested whether it need be done like medicine, exclusion instead of inclusion. Is that the issue with the entire thing? We include specifics instead of excluding, where exclusion lay upon another diagnosis better?

I don't know that's true. Is there evidence for this?

Not sure... but there are certainly interesting well cited studies and journals of relevance to such aspects:

• http://www.ncbi.nlm.nih.gov/pubmed/17055216
  
• http://www.ncbi.nlm.nih.gov/pubmed/15927781
  
• http://www.ncbi.nlm.nih.gov/pubmed/17064877
  
• Link Removed
  
• http://bjp.rcpsych.org/content/186/6/494.full?linkType=FULL&resid=186/6/494&journalCode=bjprcpsych
  
• Dead Link Removed

 

[anthony]

So at the moment we're at:

A. Direct exposure to actual or immediate threat of death, catastrophic injury, or sexual violence. (Does not apply to exposure to electronic media, television, movies, or pictures, unless the exposure is work related for a period of longevity.)

 

[anthony]

When reviewing criterion A, it is hard to dismiss previous journal discussion and study comments. The last linked piece is one of my favourites:

Early proponents of the diagnosis of post-traumatic stress disorder were part of the antiwar movement in the United States; they were angry that military psychiatry was being used to serve the interests of the military rather than those of the soldier-patients. The propo- nents lobbied hard for veterans to receive specialised medical care under the new diagnosis, which became the successor to the older diagnoses of battle fatigue and war neurosis. The new diagnosis was meant to shift the focus of attention from the details of a soldier’s background and psyche to the fundamentally trauma- togenic nature of war. This was a powerful and essentially political transformation: Vietnam veterans were to be seen not as perpetrators or offenders but as people traumatised by roles thrust on them by the US military. Post-traumatic stress disorder legitimised their “victimhood,” gave them moral exculpation, and guaranteed them a disability pension because the diagnosis could be attested to by a doctor; this was a potent combination.

An editorial in the American Journal of Psychiatry commented that it was rare to find a psychiatric diagnosis that anyone liked to have but post-traumatic stress disorder was one.

Originally framed as applying only to extreme experiences that people would not expect to encounter every day, it has come to be associated with a growing list of relatively commonplace events: accidents, muggings, a difficult labour (with healthy baby), verbal sexual harassment, or the shock of receiving (inaccurate) bad news from a doctor even in cases in which the incorrect diagnosis has been rescinded shortly afterwards.

The constructs of “psychology” or “mental health” are social products. Collectively held beliefs about particular negative experiences are not just potent influences but carry an element of self fulfilling prophecy; individuals will largely organise what they feel, say, do, and expect to fit prevailing expectations and categories.

And a piece of writing I love the most: But human pain is a slippery thing, if it is a thing at all: how it is registered and measured depends on philosophical and sociomoral considerations that evolve over time and cannot simply be reduced to a technical matter.

Mental health diagnosis, period, is philosophical, not evidence based.

This is an opportunity to turn everything upside down, if we see fit. Or we try and refine existing content. Or we amend with various unique ideas and solutions.

 

[digger]

What is the current wording of the ICD equivalent of criteria A requirements? I can't find it at the moment, but I seem to remember it was more loosely worded? Not sure if that's a good or a bad thing but maybe worth throwing out there if we're talking diagnosis.

(Will edit if I find it again before someone else)

 

[anthony]

ICD 10 PTSD

I updated the third post with the ICD 10 version.

https://www.myptsd.com/threads/lets-create-a-ptsd-diagnosis.60515/#post-978742