What Are The Main Differences Between Ptsd And Complex Ptsd?

[Justmehere]

@Lucycat - Ah, you make a good point.

I can also understand. There is TREMENDOUS stigma around BPD, and mental illness in general. BPD seems to be especially stigmatized among mental health care professionals. Education and understanding is key for handling any diagnosis well.

Hmmm, I just realized I think that's why I am pushing back so much against some of these claims about BPD. It's hard for me to see another health care professional declaring ideas about BPD without evidence and claiming it is such an unchangeable diagnosis that such a diagnosis dictates a certain kind of life with no hope for lasting recovery. I feel alarmed about this, as I fear this kind of perspective, with no evidence, fuels the problem that people with BPD are sometimes treated so badly, when they should not be treated badly.

 

[Hashi]

This thread seems to have gone way off topic with discussions about Aspergers, and as some others have asked I'm wondering in what way all the consideration of Borderline Personality Disorder is relevant.

To me, what's important is why we might want/need a differentiation between PTSD after complex trauma and PTSD after non-complex trauma (if that's the right phrase).

IMHO, most of these arguments about diagnosis dilution comes down to both societies demands on having labels if you only borderline a diagnosis + the therapeutic model now being more business oriented than well-being oriented.

I got a bit lost with the grammar here but if I understand right you're saying the diagnosis is more about business, or that people are often given a diagnosis that barely fits, for business reasons? I don't see this much, at least not in my experience in the UK. If it happens then I think there's a risk of throwing the baby out with the bathwater because of it. People may use labels to their own advantage and not in the best interests of clients, but I don't think that means we should throw out the labels because they are there for other reasons too.

I'm not a fan of labels in general and I think they can become counterproductive in various ways. However, I think they have three important uses:

a) Understanding symptoms and reactions
b) Having appropriate treatment
c) Avoiding inappropriate treatment

Personally, I think CPD exposure therapy is a very different proposition for someone with complex trauma, compared to someone with a psychological baseline of relative stability that has been rocked by a traumatic incident. Other people may not agree. However, my point would be that without having distinct categories that are considered and reported on in research and experience, it's hard to consider the appropriateness of treatment.

I'm a bit lost with regard to this point:

Explain to me with the term CPTSD, exactly how PTSD has become complex as a diagnosis, when firstly the above point that the diagnosis isn't even of a PTSD nature, and secondly, it is the trauma that complex due to failing the prior point.
So how does anyone derive Complex PTSD when PTSD symptoms aren't even used, and in actuality are nothing like PTSD, yet they use PTSD as a claim to incite validity within their argument?

I suppose this is about current proposed diagnostic criteria? But then there is also:

By several persons own admissions, as your own above, you don't really fit PTSD diagnostic criterion and your suffering isn't specific to post traumatic. Your symptoms are due to ongoing traumatic, and often during childhood. Saying that, it isn't isolated to childhood and ongoing trauma occurs to adults where their personality misaligns due to the significance of trauma, such as POW's, longevity torture and captivity cases as adults.

I'm sorry if I'm finding it hard to follow - this is a tough thread for concentration!

Why wouldn't people fit PTSD diagnostic criteria? I did, from complex trauma. Why is this ongoing rather than "post", if it's in the past? I mean, it was ongoing at the time but not now. Hence the distinction of complex trauma. But why a distinction that it doesn't fit PTSD?

To me, it has been PTSD with a great extent of problems with dissociation, amnesia and childhood development. The PTSD has definitely been part of it, though, and I feel that the PTSD diagnosis has been significant for my therapy, treatment and own approaches. Some (not all) PTSD treatment approaches have been essential for me.

I'm of the viewpoint that complex trauma can frequently give rise to "PTSD plus additional symptoms specific to complex trauma". To keep a single diagnosis of PTSD but have to forever add in the distinction like that, is problematic IMHO. It stops these aspects from being a fundamental consideration in research and treatment. Equally, I would find it problematic to take away the PTSD from the diagnosis. I see this as being similar to any overall diagnosis that has sub-categories.

Maybe the current proposals for criteria for PTSD (or other disorder) after complex trauma, and what it would be called, aren't ideal. I still think it would be useful to have a diagnosis that takes both PTSD and complex trauma into account, together.

 

[NovemberStar]

@Butterflywings - I agree in general with a lot of what you say BUT I don't quite agree when you say 'those with BPD can't be recovered' - I think there can be a fine line differentiating between those who DO have BPD but learn to manage their symptoms and can go onto live a fully functional life, with those that never had it in the first place.

Much of the literature around BPD does suggest that 'with tim'e many of there more intense symptoms CAN be 'controlled' and the person not really appear to have BPD at all - especially when they become older - i.e., women in their late 30s and 40s 'outgrow' BPD - with treatment. But in most of those cases, it is like you say, a general slow but gradual improvement. Less episodes of del;f harm less intense relationships. Very different to distinct, intense apparent' 'episodes' of 'BPD'.

I had a close friend with BPD. She did get better, and by the time she was in her early 40s, she no longer self harmed or 'acted out' in the ways she used to. I guess she could be considered 'recovered'. She definitely did have BPD. She used a lot of CBT to learn to challenge her thoughts, which lead to her not acting out on them, so she managed her behaviors.

The difference between her and I on the outside was - she had to learn to 'manage' her thoughts and feelings in order to be 'stable' - for me, when I had not PTSD for 12 years, I did not have to 'mange' anything - the 'symptoms' of BPD were not there at a ll - no thoughts OR feelings related to 'BPD' at all. I wasn't 'learning how to mange' it - I did not have it, period.

 

[Hashi]

Could I suggest a different thread about BPD? It isn't the topic of this one.

 

[NovemberStar]

@anthony - I've been thinking about what you said how the big issue with CPTSD is that there is no PTSD in the symptoms cluster - my understanding why specific symptoms of PTSD are not outlined in (most) of the critter for CPTSD is because it is assumed you have a diagnosis of PTSD to begin with.

CPTSD is simply an 'added' list of symptoms (in addition to PTSD, once that diagnoses has been made), rather than a checklist in its own right ONCE PTSD has been diagnosed. That is just my understanding anyway.

Hope that makes sense!

Also wanted to say - why there is so much confusion as to 'what' is the 'criteria' for CPTSD - is precisely why some want it to be a diagnosis - because there is no consistency.

I also want to point out - the biggest issue with the DSM in general is it is attempting to pigeon hole masses of people - and the irony is, because we are ALL different, and most of us have different symptoms (for whatever diagnosis), most of us do not neatly fit any criteria!

An example is the diagnosing criteria for Anorexia or Bulimia - most people with eating disorders have symptoms of both, could be called anorexic or bulimic to the lay person in terms of the most basic of symptoms (i.e. severe restriction, weight loss for anorexia, and / or bingeing and purging for bulimia) YET - vast majority of people with an eating disorder don't FULLY meet either criteria - they are diagnosed as 'EDNOS' (eating disorder not otherwise specified).

So you have - the two main eating disorders and the MAJORITY of people with an eating disorder do not meet either criteria. I think it's probably like that for a lot of mental health illnesses - few meet the boxed criteria. So the solution? The DSM keeps being added too, to try to 'capture' the bulk of people with a mental illness. SO more and more labels are added. And they STILL don't capture everyone.

In the meantime it might be those who might otherwise fit the criteria for CPTSD are instead diagnosed with PTSD and Dissociative disorder NOS or any other 'NOS' - and eventually, there will be so many people withy 'NOS' that (CPTSD as a sub group of PTSD) probably will be re-evalued - lol, cos they always want to get the 'box' right!

That is the limitation of the DSM (or any other standard) and will probably always be the problem - few people nicely fit the boxes.

 

[NovemberStar]

@Hashi - I don't think you can get away form the topic of BPS when discussing CPTSD - because its the criticism of the 'BPD' diagnosis that CPTSD has in part, sprung up from. Judith Herman's big argument is BPD is a diagnosis given to too many people who don't have it and that in her option (and mine) a diagnosis of CPTSD (INSTEAD of PTSD and / or BPD) is more appropriate. And for many of the reasons I have outlined in my experience - misdiagnosis caused me a lot of harm, and did nothing to help me deal with my trauma.

If I had not been misdiagnosed with 'BPD' I would have been treated for the real issue - trauma. IF CPTSD had been in the DSM 20 years ago, I would have likely been diagnosed with that, instead of BPD. I had PTSD, but it was not recognized. And as a result, I was treated horribly - can you imagine,, depressed, suicidal, with PTSD, and reaching out for help, to be 'treated' like you are lying, manipulating, attention seeking? Told you are not really suicidal, but you 'just want attention'? Being denied anti-depressants and other meds to help the PTSD, because they won't work since you have a 'personality disorder'? Can you see how damaging that would be, to someone with PTSD? Probably was the WORST possible response the mental health providers could give to someone with PTSD!

That was my problem (back then) with it not being recognized as a disorder - my misdiagnosis.

 

[Hashi]

If I had not been misdiagnosed with 'BPD' I would have been treated for the real issue - trauma. IF CPTSD had been in the DSM 20 years ago, I would have likely been diagnosed with that, instead of BPD.

I think that's all you need to say.

The thread has a lot of discussion of the prognosis for BPD, treatment for BPD, management of BPD, stigma of BPD and experiences of BPD. Not much of it is the need for a CPTSD diagnosis to avoid misdiagnosis as BPD. I'm not sure anyone has disputed that misdiagnosis as BPD can occur/has occurred... have they? I may have missed it if so. If not, then it has been accepted and doesn't need restating.

At any rate, it doesn't seem to be what most of the ongoing BPD discussions are about. They seem to be mostly concerned with issues around BPD rather than misdiagnosis of someone with PTSD after complex trauma, due to the lack of appropriate diagnostic criteria.

 

[Hashi]

Oh OK, I've looked back on the thread and Judith Herman has linked BPD criteria to "Complex PTSD" criteria? Is that right?

In that case, I give up on the discussion. I'm finding it too hard to pick out what people are saying about Complex PTSD diagnosis and how much the discussion about other things, like Aspergers and BPD, is within that discussion or outside it. I can't follow, will leave.

 

[anthony]

Sorry not meaning to be difficult Anthony but I was asking why you believe they are the same diagnosis. I've spent days now looking up DESNOS and I can't see much overlap in symptomology with CPTSD at all.

I hope you aren't trying to use Hermans original diagnostic criteria that she proposed 20 years ago. She has somewhat changed her criterion over time, and now works hand in hand with Van der Kolk and others who all agree on similar proposed criterion.

CPTSD is simply an 'added' list of symptoms (in addition to PTSD, once that diagnoses has been made), rather than a checklist in its own right ONCE PTSD has been diagnosed. That is just my understanding anyway.

CPTSD has never been marketed that way. It has been marketed as its own diagnosis, never comorbid to PTSD.

Even the linked documents here about CPTSD state: C-PTSD is distinct from, but similar to, post-traumatic stress disorder (PTSD), somatisation disorder, dissociative identity disorder, and borderline personality disorder.

PTSD is actually stated under these documents as a differential diagnosis, not a comorbid diagnosis.

 

[anthony]

Ok... if you find something far out here, then please tell me, because they read nearly the same to me. I will highlight all aspects within each other, to see what is left in either (all cross-over symptoms). You could actually fit some meaning into the other between them, though I am being minimalist here to prove a point about how similar they actually are, because DESNOS derived from the original CPTSD diagnosis.

CPTSD proposed criterion from Herman:

• Difficulties regulating emotions, including symptoms such as persistent dysphoria, chronic suicidal preoccupation, self injury, explosive or extremely inhibited anger (may alternate), or compulsive or extremely inhibited sexuality (may alternate).

• Variations in consciousness, including forgetting traumatic events (i.e., psychogenic amnesia), reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation), or having episodes of dissociation.

• Changes in self-perception, such as a chronic and pervasive sense of helplessness, paralysis of initiative, shame, guilt, self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings

• Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator (caution: victim's assessment of power realities may be more realistic than clinician's), becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge, idealization or paradoxical gratitude, a sense of a special relationship with the perpetrator or acceptance of the perpetrator's belief system or rationalizations.

• Alterations in relations with others, including isolation and withdrawal, persistent distrust, a repeated search for a rescuer, disruption in intimate relationships and repeated failures of self-protection.

• Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.

DESNOS

1. Alteration in Regulation of Affect and Impulses (A and 1 of B–F required):
   • Affect Regulation (2)
   • Modulation of Anger (2)
   • Self-Destructive
   • Suicidal Preoccupation
   • Difficulty Modulating Sexual Involvement
   • Excessive Risk-taking
2. Alterations in Attention or Consciousness (A or B required):
   • Amnesia
   • Transient Dissociative Episodes and Depersonalization
3. Alterations in Self-Perception (Two of A–F required):
   • Ineffectiveness
   • Permanent Damage
   • Guilt and Responsibility
   • Shame
   • Nobody Can Understand
   • Minimizing
4. Alterations in Relations With Others (One of A–C required):
   • Inability to Trust
   • Revictimization
   • Victimizing Others
5. Somatization (Two of A–E required):
   • Digestive System
   • Chronic Pain
   • Cardiopulmonary Symptoms
   • Conversion Symptoms
   • Sexual Symptoms
6. Alterations in Systems of Meaning (A or B required):
   • Despair and Hopelessness
   • Loss of Previously Sustaining Beliefs

@Junebug thanks for the links. Not really much in them different from other stuff floating around, though thanks for posting them.

To be perfectly honest, they just regurgitated data they sent to the APA which resulted in a fail. Not sure if this will really put further weight on a decision by WHO or not:

The LPA revealed three classes of individuals: (1) a complex PTSD class defined by elevated PTSD symptoms as well as disturbances in three domains of self-organization: affective dysregulation, negative selfconcept, and interpersonal problems; (2) a PTSD class defined by elevated PTSD symptoms but low scores on the three self-organization symptom domains; and (3) a low symptom class defined by low scores on all symptoms and problems. Chronic trauma was more strongly predictive of complex PTSD than PTSD and, conversely, single-event trauma was more strongly predictive of PTSD. In addition, complex PTSD was associated with greater impairment than PTSD. The LPA analysis was completed both with and without individuals with borderline personality disorder (BPD) yielding identical results, suggesting the stability of these classes regardless of BPD comorbidity.

What they're saying above, is recommending to the WHO a three pronged PTSD diagnosis. Complex (with heavy dissociation / personality traits), PTSD with dissociation / personality traits that aren't as prominent, then PTSD for those who endure a minor traumatic event (adjustment disorder).

Not real sure how that will fly, just personally, because once again they're mix matching existing diagnoses which are far better researched uniquely. I honestly don't think they've learned anything by failing DSM approval.

 

[NovemberStar]

@anthony - where are your quotes /info from? I ask cos the ones I have read that are similar, are from wikipedia, and I (think) capture what it is I have read about cptsd criteria?

I'm finding it really hard to follow all of this by the way - it hurts my brain ….

 

[anthony]

The DESNOS is from Van der Kolks published submission of his diagnostic criterion for admission to the APA / ICD. The CPTSD is from wiki content. The wikipedia one may be a little different... though wouldn't be much different if you do the same thing. Go lookup the defined meaning of words, then cross-compare. There is very little difference between them both, because they are the same thing... just evolved by two different people, of which those two people work together on complex trauma diagnosis.

CPTSD and DESNOS are the same diagnosis. From Van der Kolk himself:

Clinicians will learn to understand the progressive developmental impact of traumatic experiences that compromise ongoing psychological, biological, and social maturation and lead to a diagnosis of Complex PTSD or Disorders of Extreme Stress, Not Otherwise Specified (DESNOS). They will also learn to recognize the clinical symptomatology of this condition and how to assess patients for it.

CPTSD has four names:

1. Complex Post Traumatic Stress Disorder (Failed submission acceptance)
2. DESNOS (Failed submission acceptance)
3. Multiple interrelated post traumatic stress disorder (Pulled from Hermans book for possible name change)
   
4. Enduring personality change after catastrophic experience (Legal diagnosis currently listed in ICD 10)

The key persons in complex trauma research don't accept #4 listed as valid, because they're lost in trying to associate it with PTSD, because PTSD is the "in" diagnosis most recognised for any traumatic event. If they achieve that, they achieve instant recognition beyond any already received.