Acute Stress Disorder, Post-Traumatic Stress Disorder, and "Complex" PTSD

[David Baxter PhD]

Re: One more positive update

Note that "Complex PTSD" is not at present a recognized diagnosis:

Complex PTSD - (National Center for PTSD)

The diagnosis of PTSD accurately describes the symptoms that result when a person experiences a short-lived trauma. For example, car accidents, natural disasters, and rape are considered traumatic events of time-limited duration. However, chronic traumas continue or repeat for months or years at a time. Clinicians and researchers have found that the current PTSD diagnosis often does not capture the severe psychological harm that occurs with such prolonged, repeated trauma. For example, ordinary, healthy people who experience chronic trauma can experience changes in their self-concept and the way they adapt to stressful events. Dr. Judith Herman of Harvard University suggests that a new diagnosis, called Complex PTSD, is needed to describe the symptoms of long-term trauma. Another name sometimes used to describe this cluster of symptoms is: Disorders of Extreme Stress Not Otherwise Specified (DESNOS).

Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met criteria for PTSD, Complex PTSD was not added as a separate diagnosis. Complex PTSD may indicate a need for special treatment considerations.

To my mind, individuals who show only short-term reactions to trauma are not properly diagnosed as PTSD in the first place. Rather, they should be given the diagnosis of 308.3 Acute Stress Disorder (or possibly 309.81 Posttraumatic Stress Disorder, Acute):

Diagnostic criteria for 308.3 Acute Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror

B. Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:

(1) a subjective sense of numbing, detachment, or absence of emotional responsiveness
(2) a reduction in awareness of his or her surroundings (e.g., "being in a daze")
(3) derealization
(4) depersonalization
(5) dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

C. The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.

D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people).

E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.

G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event.

H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

as opposed to:

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response

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

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

Specify if:

Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

This, if clinicians followed published criteria for these two diagnoses, there would be no confusion and no need for an additional diagnosis, since only individuals with enduring post-traumatic stress reactions would be given the diagnosis PTSD or PTSD, Chronic, which is exactly what the DSM-IV Committee concluded.

 

[braveheart]

Re: Acute Stress Disorder, Post-Traumatic Stress Disorder, and "Complex" PTSD

Why's dissociation included in ASD but not PTSD? [and of course it's included, quite rightfully, in Complex PTSD.]

:juggle:

 

[David Baxter PhD]

Re: Acute Stress Disorder, Post-Traumatic Stress Disorder, and "Complex" PTSD

It is included in PTSD:

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).

 

[GDPR]

Re: Acute Stress Disorder, Post-Traumatic Stress Disorder, and "Complex" PTSD

Note that "Complex PTSD" is not at present a recognized diagnosis

Is it now?I don't think it is....

But,I think it is a 'proper' term. I have been diagnosed with PTSD,a personality disorder and a dissociative disorder.But Complex PTSD,I think,would be a more accurate diagnosis instead of 3 separate ones.

 

[David Baxter PhD]

Re: Acute Stress Disorder, Post-Traumatic Stress Disorder, and "Complex" PTSD

No. See http://forum.psychlinks.ca/just-chat/30137-what-are-you-currently-reading-6.html#post231588

 

[Potcake]

Re: One more positive update

Is it possible that a diagnosis of PTSD after a traumatic event as a teenager could reignite in later years...as long as 30 to 40 years after the event? I suppose you wouldn't know for sure without interviewing the patient, but if they are resistant to professional intervention, we are left to guess work and walking on eggshells.

 

[David Baxter PhD]

Re: One more positive update

Is it possible that a diagnosis of PTSD after a traumatic event as a teenager could reignite in later years...as long as 30 to 40 years after the event? I suppose you wouldn't know for sure without interviewing the patient, but if they are resistant to professional intervention, we are left to guess work and walking on eggshells.

Yes it's possible.