Lets Create A Ptsd Diagnosis

[joeylittle]

So, here's a can of worms...

How overlapping vs. distinct should cPTSD be when looked at against the personality disorders?

It seems to me that the only thing separating cPTSD from the general criteria for a personality disorder is the existence of crit. A trauma, specifically. That's not necessarily a problem, but it's a thing to keep track of.

Any opinion about how parallel (or not) the language should be? And how this might influence structure?

 

[anthony]

I think there will be crossover, no doubt about that, but the inherit issue that I understand is that many have these regulation issues relating to more PTSD criterion than isolated personality disorder criterion, and more often than not, those with the additional regulation problems don't fit a personality disorder.

With the removal of the Axis system, I believe that was a just leap forward away from this isolated component that personality changes in childhood prior to age 18, as combat veterans, POW's, adult captives, present with the same outcomes of those affected in early childhood. With all the research into this, more is presenting that personality is not fixed like previously believe, hence the evidence supported dropping the Axis system as a result.

So I believe this opens all diagnoses to crossover with personality disorders to some degree, and obviously the worse the disorder, the more likely the crossover. There is too much like PTSD that is really just exacerbated by regulation issues that differ from personality disorder.

 

[oasis2003]

I do not have any thing constructive to add a part from it being such a complicated and diverse set of symptoms and histories to be able to categorise. When does cPTSD become a personality disorder ? What defines them from one another. With neuroplasticity of the brain can some of the symptoms be eliminated ?

 

[anthony]

With neuroplasticity of the brain can some of the symptoms be eliminated ?

I'm not sure that has ideal logic from a diagnostic view. What I think you're saying, is combining recovery with diagnosis, for the complex cluster. Recovery, regardless how it is done per symptom, has nothing to do with whether the symptom exists/existed based on trauma.

Don't get me wrong, at present it is convoluted, though this is only building upon the present system. There is an alternative to all of this which will be discussed once this is finalised. Once complex symptoms are nailed down, it is just one way of many to do things.

 

[anthony]

Ok, having had some time to think about this, I think trying to fit regulation into the diagnosis as a cluster is a killer. So... with much thinking, maybe the best option is to expand what is partially started with the addition of specifiers?

So leave F, G & H as standard, with the exception that I'm quite honestly not sure whether we need (1) month as the duration with (6) months as delayed expression. Who really cares when PTSD appears versus it is present and IS PTSD. I think split the difference maybe, change the disturbance duration to (3) months and remove the delayed expression entirely.

Thoughts?

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

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

H. 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 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 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).

Specify if:

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).

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I would change the additional specifier to include:

3. Regulation: Persistent inability to regulate emotion leading to suicidal tendencies, self-mutilation and self-destructive behaviors.

Thoughts????

 

[Sideways]

Re the definitions for depersonalisation and derealisation, are they meant to be the same (the brackets are different, but depersonalisation is a feeling of not being resl yourself, or not being really connected to your body, rather than your surroundings)??

 

[anthony]

You know, nobody has picked up that error in the original posting here. The adult version was wrong, the child version I had right. Now amended at the source and here, thanks @Ragdoll Circus for finding that one, appreciated.