Understand complex ptsd (cptsd)

[CarolKaz]

Compared to many of you my life has been a bed of roses. It would be great to try to figure out the why of anything.

 

[Deleted member 487]

Anthony, in your writing you say that unless my doctor is working with WHO then I have not been diagnosed with cPTSD. My question is, are those doctors with WHO licensed to practice in a) the United States and/or b) licensed to practice in any of the individual states within the United States? Because unless they are then any diagnoses they provide on Americans within American boundaries are not valid. Perhaps WHO has some level of authority where you're from, but last I knew they really don't have much if any authority in Utah.

It bothers me that people with minimal credentials start making judgment calls on official diagnoses without observing the testing or having access to any of the reports/test results.

I understand that you mean well, but is this something I feel may be outside your level of expertise.

 

[anthony]

I have no idea what part is outside my expertise level? I honestly have no idea what you even mean about WHO.

Do you know who WHO is? Do you know there are only two mental health manuals in the world, and that both exist together, cross referencing one another? That both their codes are global standards, even in USA?

ICD coding was introduced in the USA from ICD 10. I don't know how far the USA insurance system works with ICD (WHO), but it is part of the USA health system, so I imagine the insurance standards too. As CPTSD was introduced into ICD 11 this year, and is now officially a diagnosis, CPTSD diagnosis now exists.

Really super uncertain what you're even asking / referring to. Twice in one day, members being super vague in article posts to me.

 

[bigstrongtree]

Where does one find an “excellent trauma therapist”? I’ve been looking for years and haven’t been able to find even a good one, much less an excellent one.

I found my therapist in a clinic that serves domestic violence and crime victims.

 

[Deleted member 487]

I checked with my counselor Anthony, and she said she's gonna double check with her boss, but last she knew WHO has zero authority/business to make any determinations inside the US. I should find out tomorrow about that.

The issue here is, cPTSD has been recognized by practitioners and state health agencies as far back as 1988 that I know of..

 

[anthony]

I checked with my counselor Anthony, and she said she's gonna double check with her boss

Ok. A counsellor isn't a psychologist though... so I hope her boss is a Ph.D or Shrink. @joeylittle may know the specifics for WHO within the USA, as to whether or not they recognise it within diagnostic and insurance aspects.

Whether cPTSD was recognised by practitioners, has no bearing on matters. Recognition and diagnosis are very different things. Its easy to say, "hey, you have cPTSD." Then the patient goes, "Ok, what's that?" Then the diagnosing physician tells them, and is then questioned as to why their diagnosis reads, PTSD, depression, anxiety, dissociative disorder, personality disorder maybe, blah blah.

Hang on. Didn't the person just say I had cPTSD? Well yes... but its not really a thing then, because if their is no "actual" diagnostics to be applied, why on earth would any physician be telling a patient they have something that doesn't actually exist diagnostic wise? Even criterion?

Just Googled this and found: "The National Center for Health Statistics (NCHS), a federal agency within the Centers for Disease Control and Prevention (CDC), oversees the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CM) in the United States."

Changes to ICD-10-CM Codes for DSM-5 Diagnoses

Like I said... look to shrinks or such, not counsellors, for quality information about WHO within USA, specifically mental health doctrine association / classification / inter-linking between the two manuals. If you take a look at the code updates, you will see ICD codes referenced for disorders not within the DSM. The last update is still referring to the ICD 10-CM, which was the latest, and is still used... but only recently superseded by the ICD 11. It will take them time to release another update, but they will, and it will include cPTSD ICD code. I imagine you could use the ICD 11 code now, and internal insurance systems and such would have more updated systems. Maybe? Expecting them to be more updated... usually due to the financial aspects! Never do know though :)

 

[joeylittle]

last she knew WHO has zero authority/business to make any determinations inside the US. I should find out tomorrow about that.

She's incorrect. WHO sets the diagnostic codes, via the ICD.

Here's how the DSM, ICD, and WHO interact, in the US -

Since 2003, ICD codes have been mandatory (per HIPAA) for third-party billing and reporting for all electronic transactions for billing and reimbursement. They are the World Health Organization (WHO)’s International Classification of Diseases and Related Health Problems and used in conjunction with CPT for billing.

So, technically, the WHO is actually at the top of the chain, code-wise. Link Removed (my bolding for emphasis):

Because the DSM endorses (and therefore lists) most mental / behavioral health ICD codes (but excludes some), and because it's the only accepted guide to ICD for our industry, many providers believe that DSM and ICD codes are separate. They're not: DSM is ICD. Most of us use the language "DSM codes", but there is no list of DSM codes separate from ICD codes. DSM directs you to the correct ICD diagnosis code(s). Even if psychologists record DSM diagnostic codes for billing purposes, payers recognize the codes as ICD-9-CM, the official version of ICD currently used in the United States.

Now, codes are assigned to diagnoses, and diagnoses have criteria. A person who is licensed to diagnose mental health in the US (so, a physician, psychiatrist, psychologist, and certain others in certain states - it varies) can use the diagnostic criteria in either the DSM or the ICD. The DSM is more detailed, since it's only covering one area of medicine (the ICD is for everything). The DSM and ICD don't generally contradict each other, especially not since the DSM IV, but they do lay out their criteria differently.

The issue here is, cPTSD has been recognized by practitioners and state health agencies as far back as 1988 that I know of..

Yeah, but if it's not integrated into the DSM or ICD, there's no way to assign it a number and slap it on a person.

I'd say that c-PTSD was recognized pretty firmly in the field after 1997, when Judith Herman's book Trauma and Recovery came out, and she made a clear case for a separate diagnosis of c-PTSD. There's no question (in my mind) that psych professionals understand there's a difference in the ways PTSD and c-PTSD present themselves.

So, there have been work-arounds.

During the DSM IV and IV revisions (lined up with ICD-9) the common practice was to use the code for Disorders of Extreme Stress Not Otherwise Specified (DESNOS), as a stand-in representing Complex PTSD. The diagnostic criteria for DESNOS was considered to be the closest/most useful. From the National Center for PTSD

Another name sometimes used to describe the cluster of symptoms referred to as Complex PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS)

In DSM V and ICD-10,. DESNOS is still a coding option.

I found an interesting essay here that has a different suggestion:

The current ICD-10 includes a diagnosis of Enduring Personality Change After Catastrophic Experience (EPCACE) in the Disorders of adult personality and behavior section. This is regarded as equivalent to Complex PTSD

They cite the WHO beta draft of ICD-11 for that. I've also seen that info in this guide to the diagnostic differences between DSM and ICD, in re: PTSD.

Personally, if my doc was looking to code me for C-PTSD, I'd prefer to go with DESNOS, and stay in the trauma/stressor disorders area.

If anyone wants to see the madness that is CPT coding...I'll offer up a link to the PTSD coding fact-sheet for primary care pediatricians . I'm sorry it's for pediatricians, I really could not dig up one for just regular GPs or psychs. But, there's no real difference, just in terms of seeing how all the things are accounted for. This guide advises it's docs to

Use as many diagnosis codes that apply to document the patient’s complexity and report the patient’s symptoms and/or adverse environmental circumstances. Once a definitive diagnosis is established, report the appropriate definitive diagnosis code(s) as the primary code, plus any other symptoms that the patient is exhibiting as secondary diagnoses that are not part of the usual disease course or are considered incidental.

Given all of this - it's not really surprising that most docs would prefer to tell a patient they are diagnosed with c-PTSD, as a kind of shorthand. They can't list it as the actual diagnosis, because it's not there. But there are ample codes to assign that reflect the spectrum of symptoms.

Sources:
Link Removed
Complex Post-traumatic Stress Disorder. (Aug 29, 2018). Traumadissociation.com. Retrieved Aug 29, 2018 from Complex Posttraumatic Stress Disorder Symptoms and Diagnostic Criteria.
Complex PTSD - PTSD: National Center for PTSD
http://www.psychiatrictimes.com/ptsd/ptsd-dsm-5-understanding-changes
ICD vs. DSM
Post-traumatic stress disorder - Post-Traumatic Stress Disorder - PubMed Health - National Library of Medicine - PubMed Health

 

[Deleted member 487]

Ok, this is the reply I got-

"Well, first of all the WHO is a policy organization. Not research or treatment, but...
Also the only mental health policy initiative they have to my knowledge is depression.

As far as the ICD coding system it's just that a coding system for quanitative tracking of incidence and prevalence of health conditions. It does not guide treatment. If it is included, it will only be calling a rose by another name.

Previously cptsd has been called "personality disorders", namely the borderline type but all of the personality disorders have their roots in prolonged trauma."

In my previous dealings, cptsd has been recognized way back to the late 80's. Of course I also recognize that my family and I was given information on head injuries (which is the focal point of my PTSD) that was allegedly "current" & "up to date", yet I found out years later was actually from the f'ing 1960's. And my first Traumatic Brain Injury was in 1987.

What confuses others, and myself, is how I was able to get enlisted in the US Army in 1992. I gave the USA ALL of my medical records, including all medical and psych records regarding my TBI in 1987, including the names and contact information for every doctor involved. So when they accepted those, I considered it good to go. The recruiter considered it good to go. Hey, if MEPS and MEPSCOM accepts it, it IS good to go. Right?
(MEPS = Military Entrance Processing Station; MEPSCOM = Military Entrance Processing Station Command)

For a long time my TBI was labeled "CHI" & "SCHI", for Closed Head Injury and Severe Closed Head Injury. Glasgow Coma score was used, not the Rancho Trauma Diagnosis Code.

I think what the problem is here is the lack of communication. Too many doctors, such as thosethat initially diagnosed me with CPTSD (which were licensed physicians, namely 2 neuropsychs. 1 psych & 1 neurologist, and I can get you their names if you want them).

As for the Army, I'm still left scratching my head. But that one is a long story.

 

[anthony]

Ok, this is the reply I got-

"Well, first of all the WHO is a policy organization. Not research or treatment, but...
Also the only mental health policy initiative they have to my knowledge is depression.

You just need to stop talking with complete and utter idiots. I'm not talking with you about this further, as you just seem to be trolling, argumentative, and ignorant to facts: Research

About WHO

Maybe read more, get educated, and stop listening to idiots. WHO are embedded in everything public health oriented, usually behind the scenes.

I'm done with you.

 

[Deleted member 487]

Anthony, yeah. This is your website. And somehow that gives you the right to verbally abuse me and insult my counselor. You don't even know her. You know nothing more than a few pieces I said about her. And you insult her. Just like the first time I brought up cptsd and you said it doesn't exist.

I hope you feel better Anthony. You can verbally abuse people and get away with it. You're right- you DO need help.

Up to you where it goes from here, but I'm going to find a doctor and get his/her take on this.
Maybe you're right. If so, I'll apologize to everyone here. But if I'm right...nah, you'll just insult me again.

 

[joeylittle]

@cactus_jack - did you read my post, or did you just skip past it so you could continue feuding with Anthony?

I'm going to quote the factual relevant bit - which, you'll notice, doesn't really contradict anything you've been told, it's just a more detailed answer:

Given all of this - it's not really surprising that most docs would prefer to tell a patient they are diagnosed with c-PTSD, as a kind of shorthand. They can't list it as the actual diagnosis, because it's not there. But there are ample codes to assign that reflect the spectrum of symptoms.

Your therapist said -

As far as the ICD coding system it's just that a coding system for quanitative tracking of incidence and prevalence of health conditions. It does not guide treatment. If it is included, it will only be calling a rose by another name.

Correct, it does not guide treatment. None of the diagnostic manuals do.

That's a different but related book, which goes along with the ICD...the ICPM (International Classification of Procedures in Medicine) and the third volume of a thing called the ICD-9-CM (CM = clinical modification). These are also published by WHO.

I think what the problem is here is the lack of communication. Too many doctors, such as thosethat initially diagnosed me with CPTSD (which were licensed physicians, namely 2 neuropsychs. 1 psych & 1 neurologist, and I can get you their names if you want them).

I think the problem is lack of communication as well, esp. on this thread.

No-one wants you to breach your own confidentiality by providing the names of your doctors. And what would any of us do, call them and ask about your file? Of course not.

At the same time, I would be surprised if your diagnosis was coded as CPTSD, because it's not yet available by itself, with it's own code.

Like your therapist said:

Previously cptsd has been called "personality disorders"

And like I said (which is the same, but with more detail):

During the DSM IV and IV revisions (lined up with ICD-9) the common practice was to use the code for Disorders of Extreme Stress Not Otherwise Specified (DESNOS), as a stand-in representing Complex PTSD.

In DSM V and ICD-10,. Link Removed

The current ICD-10 includes a diagnosis of Enduring Personality Change After Catastrophic Experience (EPCACE) in the Disorders of adult personality and behavior section. This is regarded as equivalent to Complex PTSD

So: CPTSD can be diagnosed as DESNOS, as EPCACE (far less likely in the US), or as straight up PTSD with any number of additional features. This is accurate going back to the ICD-9, which went into effect in 1975.

I'm not sure what this:

I'm going to find a doctor and get his/her take on this.

Is about, specifically. I'm guessing (hoping?) you want to talk to a doc about this:

What confuses others, and myself, is how I was able to get enlisted in the US Army in 1992. I gave the USA ALL of my medical records, including all medical and psych records regarding my TBI in 1987, including the names and contact information for every doctor involved. So when they accepted those, I considered it good to go. The recruiter considered it good to go...For a long time my TBI was labeled "CHI" & "SCHI", for Closed Head Injury and Severe Closed Head Injury. Glasgow Coma score was used, not the Rancho Trauma Diagnosis Code.

FWIW, quantified medical often trumps quantified psychiatric. However they classed your TBI, it would probably have been more meaningful to most doctors as a basis for any psych diagnosis. You'd need to go back to the ICD - not for psychiatry, but for neurology - as well as relevant research, and look at what was considered 'within norms' for enduring personality changes following brain injury between 1987 and 1992.

Anyway - I'm just offering this up in good faith. It's clear you're trying to sort something out, and if I can be helpful, happy to be.
_________

Speaking as the site Admin: You've clearly got an axe to grind with Anthony. It stops right here, right now. If not, you'll be taken off this site. Whatever you've said to each other in the past, I don't care. I'm tired of managing it. Lose the grudge or leave the site.

 

[Deleted member 487]

I did not skip over your post. Not before and not now. What I see is all this code talk. Which is to me, garbage. As you and my counselor said, the codes do not define treatment. My previous doctors and counselors did not bother me with the coding issues because I'm not the billing agent. So ICD and WHo and all these other acronyms mean nothing. DSM-IV & V mean little, as they have even said it's not there. It's a guide, but in session you'll find stuff the DSM series may not cover for a long time. Look at how long it took for the DSM-V to be approved after peer-review. How many years? Am I wrong when I say a decade, at least?

I'll lose the grudge when Anthony is capable of not insulting people. There is a specific reason why I do not contribute to this group. And Anthony's verbal abuse and refusal to discuss the matter so it can be resolved with no conflict is the reason. If that means getting banned from here, I'm not stopping you. But I'm not gonna keep my mouth shut about this, either.