Lets Create A Ptsd Diagnosis

[Sideways]

What about sticking more with examples of hypervigiliant behaviour. Eg

3. Hypervigilance, expressed as ... (examples of hypervigilant behaviours) whether related or unrelated to the traumatic event(s).

 

[anthony]

Yup, sounds good. I agree with ragdoll though, it should be kept minimal, and if you can cull the below further, I think that would be good.

Hypervigilance, a heightened sensitivity to potential threats (e.g. following a motor vehicle accident, being especially sensitive to the threat potentially caused by cars or trucks, being fearful of suffering a heart attack) whether related or unrelated to the traumatic event(s).

 

[joeylittle]

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).

I broke up the examples, because one is related to the trauma, and the other, not. I think dropping the words 'expressed as' alters the meaning too much, makes it an either/or statement, when the second clause is really meaning to provide detail to the first. 'Expressed as' does that.

?

 

[anthony]

Ok, so we have:

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.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

So, problems with concentration. Add to it, or not?

Problems with concentration, such as difficulty remembering daily events or attending to focused tasks (e.g. following conversation for a sustained time).

I dropped the remembering daily events example, because in essence, everyone forgets phone numbers, that is why we have contact books in our phones now, or little phone diaries. I also cut some of the waffle too. Too much?

 

[joeylittle]

Problems with concentration, such as difficulty remembering daily events or attending to focused tasks (e.g. following conversation for a sustained time).

I think you can do:
Problems with concentration, such as difficulty remembering daily events or attending to focused tasks (e.g., reading, conversing)

I added reading as an example because it's such a common example on the psych inventory questionnaires.

 

[anthony]

Ok, so we have:

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).

Now for the fun part... somatization.


conversion of a mental state (as depression or anxiety) into physical symptoms; also : the existence of physical bodily complaints in the absence of a known medical condition

the manifestation of psychological distress by the presentation of bodily symptoms.

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

Purely a starting point...

 

[oasis2003]

Yes I think 3 and 5 explain how most people with PTSD have symptoms in these two areas. Somatisation how about adding and pain after bodily symptoms . Do a lot of people suffer from pain within bodily symptoms ? I suppose these can be linked in bodily symptoms . I am also sure that it is bodily symptoms then psychological distress with some people it may be the other way round ?

 

[Sideways]

Obsessiveness again... Does "bodily symptoms related to the trauma" make it sound like the symptoms have to be somehow "relatable" to the event (eg. getting punched in the nose would cover unexplained tingling in the face, but not, say, unexplained nausea and gastric complaints)?

 

[anthony]

Not sure how best to say that, but more based towards somatisation is based upon the traumatic event, and not something unrelated that could be used as a symptom.

Those raped often have pain or associated body symptoms surrounding sexual areas, whether during sex or they have them when reminded by something about their trauma. Usually somatisation does not just appear, it typically has a direct link to the traumatic event in some manner.

You don't get a sore back because you were raped, as an example. You don't want people linking a sore back from lack of exercise, heavy lifting, so forth, towards their trauma symptoms.

Not sure how to best write it... suggestions?

 

[Sideways]

I think, based on that explanation, the way that you've worded it does make sense - the somatic symptom does, in fact, have to have some relation to the trauma.

 

[oasis2003]

Yes the somatisation is definitely linked to the trauma in some way, depending on which particular trauma. I should think different types of trauma create lots of variation in somatic symptoms. How to write that though other than a list and linked somatic symptoms I don't know, or some vague general explanation that covers everything but nothing Somatic symptoms must vary so widely. Is somatisation widely experienced by people who have PTSD ? Are there sets of symptoms which match specific traumas ?

 

[anthony]

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

Is somatisation widely experienced by people who have PTSD?

It is widely associated to those with complex trauma, yes. And this modification is about to enter a new cluster, F: regulation symptoms, which would then adequately cover complex trauma as cPTSD diagnosis, without all the nonsense and debate that has circulated for decades that BPD, DID and other dissociative disorders, adequately cover symptoms as comorbid or such. Whilst they do in some cases, they don't in the majority of cases.

To be honest, I'm unsure why a group of very smart psychiatrists haven't already thought about adding an additional cluster that is only applicable if labelling as PTSD, complex, as a sub-type. They already have sub-types, so this isn't that much of a stretch, requires no new categorisation or such, and doesn't split apart the post traumatic criterion for catastrophic level trauma.

I can understand them wanting to create different trauma and stressor diagnoses to cover those who endure such from financial, relationship, and such means, who do not meet criterion A, yet suffer similarly. Cut complex trauma seems to have been a pain in the APA's arse for some decades now.

Cluster F is next... and that is a complete ground up writing job.