PTSD vs Complex PTSD

[Dragonfly]

Thread split from http://forum.psychlinks.ca/psycholo...-health/25405-complex-emotional-disorder.html


I have the same understanding as Dr. Baxter - that Complex Trauma Sequelae (Complex PTSD) will likely not be included in the DSM-V as a diagnosis, when it comes out in May 2012. For my understanding and work, this is actually unfortunate. Its not that people with [regular] PTSD have symptoms that are less important, or less urgent. Its that the sequelae of repeated trauma during the vulnerable times of development - (typically childhood and adolescence) looks very different than the sequelae of a single episode of trauma. By vulnerable times of development, I am referring to critical times for both psychological and physiological (brain) development.

 

[David Baxter PhD]

Re: Complex Emotional Disorder

Its not that people with [regular] PTSD have symptoms that are less important, or less urgent. Its that the sequelae of repeated trauma during the vulnerable times of development - (typically childhood and adolescence) looks very different than the sequelae of a single episode of trauma. By vulnerable times of development, I am referring to critical times for both psychological and physiological (brain) development.

I agree to a point: Repeated trauma at early stages of development can have a different and sometimes more severe impact on the individual but not always. I would argue that the aoutcome depends very much on the interaction of several factors, including the nature of the trauma, various temperamental and personality characteristics of the victim, and how the individual processes what s/he has experienced. My argument would be against a separate diagnosis for that reason. I think we need to understand that the nature and extent/severity of PTSD is very different from one individual to another, evn where individuals experience and are reacting to the same traumatic event(s).

I think I also object to the term "Complex". I would prefer a system that uses qualifiers for severity of symptoms and whether the reaction is to a single event or multiple events, much like they do for Major Depressive Episode, among others. It seems to me that such a system, combined with GAF, would be far less limiting.

 

[Dragonfly]

Re: Complex Emotional Disorder

"I think I also object to the term "Complex"."

(I need to refamiliarize myself with how to reply with a quote....)

ummmm ..... maybe this part of the thread should / could go to the practioner's section?

I also agree to a point - PTSD and Acute Stress Disorder are unique in that these are the only diagnosis that attempt to describe behaviours that are the result of something(s) happening to an individual. And, as part of the diagnosis, we attempt to ascribe objective severity of that event (Criterion A). It seems like we are still lacking the precision that can be applied to, say, the diagnostic criteria of Major Depression. My point is that the formal diagnosis of PTSD does not adequately capture the sequelae to the sense of self / body awareness / emotional regulation that can result from repetative trauma during vulnerable periods.

 

[CarlaMarie]

Re: Complex Emotional Disorder

It would be a shame if they did not include complex PTSD in the DSM-5. I actually began to get a little hopeful that children and adults could get a diagnoisis that might accurately point to family systems work and child abuse. I find it frustrating. The big white elephant is standing in the room and no one wants to stand up and say child abuse is unaccaptable not even the American Psychological Association. It discusts me.

 

[Retired]

Re: Complex Emotional Disorder

Dragonfly,

I need to refamiliarize myself with how to reply with a quote...

Copy and paste the text you wish to quote into the reply message, composition window. Highlight the text being quoted and click on the Quote tool above the message composition window. That's it!

steve

 

[David Baxter PhD]

Re: Complex Emotional Disorder

"I think I also object to the term "Complex"."

(I need to refamiliarize myself with how to reply with a quote....)

ummmm ..... maybe this part of the thread should / could go to the practioner's section?

I also agree to a point - PTSD and Acute Stress Disorder are unique in that these are the only diagnosis that attempt to describe behaviours that are the result of something(s) happening to an individual. And, as part of the diagnosis, we attempt to ascribe objective severity of that event (Criterion A). It seems like we are still lacking the precision that can be applied to, say, the diagnostic criteria of Major Depression. My point is that the formal diagnosis of PTSD does not adequately capture the sequelae to the sense of self / body awareness / emotional regulation that can result from repetative trauma during vulnerable periods.

I agree entirely.

 

[CarlaMarie]

Re: Complex Emotional Disorder

You mean it isn't just me who sees the elephant.mg:

 

[David Baxter PhD]

Re: Complex Emotional Disorder

You mean it isn't just me who sees the elephant.mg:

No, I was responding to Dragonfly; I amended my post to make that clear.

I actually began to get a little hopeful that children and adults could get a diagnoisis that might accurately point to family systems work and child abuse. I find it frustrating. The big white elephant is standing in the room and no one wants to stand up and say child abuse is unaccaptable not even the American Psychological Association.

I'm not sure how whether or not a new diagnosis is created is going to change anything in that regard; whether you call it PTSD or Complex PTSD doesn't change the victimization and the sequelae to that victimization at all.

I would also suggest that the problem is not that "no one wants to stand up and say child abuse is unaccaptable not even the American Psychological Association". I think a lot of people including the APA have stood up and made that abundantly clear.

 

[CarlaMarie]

Re: Complex Emotional Disorder

I disagree. I think they (people in power) want to hide behind diagnoisis that victimize children and adults rather than empower them. Quiet frankly who would blame the proffessionals what a mess. Even if a diagnoisis empowers a victim toward freedom viictims, at least kids, get put into a system that disempowers them. Look at the current social service system, foster care system, and or the faith based stuff. I'm disappointed I don't get it. Where else , how else are they going to put it in. Regular PTSD does not even begin to describe the amount of trauma I experienced as a young child. Complex PTSD explains what happened to me. I own it it's my diagnoisis.I own those syptoms for so many years I had no idea what was happening to my body or to my mind and it was really nice to know it wasn't my fault. I had no control over any of the adults in my life at that time. It would have been nice to have had an accuarate diagnoisis the first time I went to a pschologist just maybe an intervention could have happened. I tried hard to get word out that something was wrong no one was listening!

 

[David Baxter PhD]

Re: Complex Emotional Disorder

Well actually it can't be your diagnosis because such a diagnosis does not exist.

But that aside, tell me:

1. why the diagnosis of PTSD does NOT describe your history and symptoms:

BehaveNet? Clinical Capsule™: Posttraumatic Stress Disorder

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

and

2. how not including the proposed new diagnosis of Complex PTSD either diminshes the severity of or condones child abuse.

 

[CarlaMarie]

Re: Complex Emotional Disorder

Well actually it can't be your diagnosis because such a diagnosis does not exist.

I am bright enough to recognize that complex PTSD is not in the DSM as of yet and therefore not my official diagnosis. It does not stop me from resegnating with the diagnosis and those professionals who write about and treat patients accordingly. I have also brought articles into my therapist to share parts of the diagnosis that fit with me. I may have all the symptoms of PTSD but that diagnoisis excludes a lot of my experience. Like my attachment issues, my abandonment issues, emotional abuse, and the sex abuse was one trauma that was by eight and then it happened all over again as an adolescent and then an adult. It makes me sad that those in your camp can't see how important that is for us it is pretty complex.

 

[David Baxter PhD]

Re: Complex Emotional Disorder

You addressed the first line of my post and not the bulk of it:

But that aside, tell me:

1. why the diagnosis of PTSD does NOT describe your history and symptoms:

BehaveNet? Clinical Capsule™: Posttraumatic Stress Disorder



and

2. how not including the proposed new diagnosis of Complex PTSD either diminshes the severity of or condones child abuse.

 

[Cat Dancer]

I went through some pretty severe stuff and my therapist treats me according to what i've been through. I do have a diagnosis of PTSD and he does take that seriously.

 

[CarlaMarie]

I've read a bunch of stuff about complex trauma on other sites it isn't here to quote and the truth is it doesn't matter. Reality is that diagnois's are really about therapist, Doctors, and providers getting paid for services. It's about money. I do get how the world goes round. I apologize, what was I thinking. I got triggered.

 

[David Baxter PhD]

Reality is that diagnois's are really about therapist, Doctors, and providers getting paid for services. It's about money.

It's not really about money, at least not most of the time. It's more about (a) communicating with other mental health professionals and (b) treatment planning.

In my practice, I rarely provide a diagnosis except when required by insurance companies, when making a referral to another mental health professional, where it is reuired for a legal proceeding of some sort, or when the client asks. In my head, though, sometimes the process of differential diagnosis is important to determine the most appropriate or effective approach to treatment and/or the most appropriate medications.

I think there are a lot of misunderstandings about diagnosis. I think that sometimes individuals fear being overly categorized, pigeon-holed by a diagnosis. But in truth, treatment of mental health issues should always be individualized. There really is no "one size fits all". That's my point really about PTSD: Everybody is different in how they react to trauma, whether it is a single severe (or not so severe) incident or a chronic series of insidents and events. Whatever the initial diagnosis, understanding the details of the trauma and the overall history of the patient are essential in devising effective treatment. And in my opinion that won't change, either for better or for worse, by adding another disagnosis or changing the name of an existing diagnosis.

 

[Justaday]

Re: Complex Emotional Disorder

I have the same understanding as Dr. Baxter - that Complex Trauma Sequelae (Complex PTSD) will likely not be included in the DSM-V as a diagnosis, when it comes out in May 2012. For my understanding and work, this is actually unfortunate. Its not that people with [regular] PTSD have symptoms that are less important, or less urgent. Its that the sequelae of repeated trauma during the vulnerable times of development - (typically childhood and adolescence) looks very different than the sequelae of a single episode of trauma. By vulnerable times of development, I am referring to critical times for both psychological and physiological (brain) development.

Yes, I'd say it makes a big difference re: treatment. Personally I think it was excluded for insurance company reasons/political reasons/pharmaceutical reasons-- so taxpayers and our health care doesn't need to feel any responsibility to cover the costs of actual treatment.

I got nailed with a big T trauma at age 10 (and a dependent) and completely life altering because it affected the whole family system, and school for me, peers, etc (my dad's suicide), hit with trauma, weakened myself and surrounded by untreated sickness around me. I think this caused me to split, and for a long time I didn't have access to my memories before the trauma, I think part of me split to protect those memories. It had a major impact on my personality development, trauma guilt, becoming a protector, rescuer. Another big T was a rape in highschool and again that also caused splitting. These events especially, had a major impact on my personality and dysfunctional coping, which set me up for more abuse. I've had a lot of big T traumas, and during when I became sick myself with ptsd, and I think my symptoms fit the Complex PTSD that Judith Herman proposed.

With a single episode trauma, it's easier to focus on the symptom management, vs. traumas that have occured in childhood and throughout different ages. It's hard to say, adult traumas when re-experiencing flashbacks, can make one feel like a child? But I guess that would also have to do with childhood traumas, even smaller T traumas?

I've had flashbacks that make me feel really young, I feel like a three year old, a 5 year old, 10, 14, 15. . . and if I'm in a bad situation, e.g. the mistake of being around an addict, who's violent, and so many triggering behaviours that resemble both sick parents all wrapped up in one-- man, it sends the brain off for a real spin. When I was raped in highschool, yes, that's had a major impact in my life, terrible trauma, even way before it was diagnosed, just totally messed up, bad habit of dissociating (cause after fighting whatever, gave up. . .)-- but I remember and more recently I think I had three split off parts making remarks about it, this confusion, a child, an younger adolescent and a me-- it's achild voice within, and a snarky toughened self, and a regulating self. . .). And when it happened again, spun, spun, spun. It's really awful.

Other thing I'm curious about re: PTSD woudl be how it connects to other dissociative disorders vs. an anxiety disorder? I think flashbacks are more of a dissociative experience, then simple anxiety, but anxiety I think often preceeds it, but so can dissociation to. . .? It's confusing, and it's hard to order. Childhood abuse involved significant relationship abuse, by the primary caregivers and the control they have over a child's life.

For a while I visited a DID site (really controversial dx), I had a really bad experience, the collection of which was sort of big T. . . I can't go there right now, but it was really splitting to me, and that's why I wound up finding the DID site, and some of their coping strategies were really useful and effective for me, e.g. art therapies-- which can help e.g. pre-verbal traumas, and make it easier to mediate among fragemented parts, to faciliate a bit of communication. Now, I don't believe I have actual alters, but I do believe I was fragemented, and just accepting that fact, made things a lot easier and re: planning and how to keep myself safer out there, teach the inner child to street proof it. It seems to have cleared up, and it's a better focus for me now to go back to basic grounding and safety and mindfulness, and I'm less scared about what comes up. As long as 'the main me' is taking care of things, there's less splitting, experiencing of fragmented selves (beyond just simple flashback). I guess it sounds almost psychotic, and not sure if I should rule that out, but it was big enough trauma (an addict, got violent, I was trapped, prevented violence an assault to another, guy threatened suicide, messed with my head emotionally, pushed himself on me, the other factors made me dissociative, guilt made me stay (rescuer/protector), had to phone the cops) and betrayal of trust and safety, violation of my boundaries, and manipulating my guilt, etc. (oh and he was dying, and thankfully I didn't become sick)-- total chaos, gangs, etc. Wasn't suppose to be like that. I went to help with food, play guitar, had a boundary no drugs around me, no sex. . .made serious errors in judgement. but couldn't get away because he created so much crisis, life threatening, violent, breakdowns, etc. After three months of this, I was totally fried again, a basket case. My belief to do right, don't let others die. . .

Child abuse is the intensity of relationship abuse, primary caregivers, control of one's world, they can either make it nice, or a living hell.

I really hate Ottawa re: access to trauma help. It's beena real struggle. Veterans get help, the ROH has a trauma program for Veterans. Having PTSD and I guess I was presenting a fair bit of dissociation when I was assessed at the ROH, but they told me that I didn't qualify for the Anxiety Disorders program because they don't treat PTSD there. So, why isn't there a dissociative disorder program? OR something that serves PTSD. I didn't chose the crap I grew up in. I even refused to become an addict, though it's all around me. I cleaned up, on my own. I tried to go to school, I volunteered and served my community and the most vulnerable (volunteered-- no private insurance deal-- stupid).

Like if people pay taxes for health care, and it is proven that PTSD does show up as a sort of brain injury, it shows up on MEG scans, yet I am denied access to treatment, vs. others with debilitating illnesses. It's NOT fair, but I've learnt to live with that, and it just strengthens my determination and I will kick this PTSD in the azz. I have a feeling that if one is poor, that it's just cheaper to let them rot on disability vs. to treat it, and I just wish that fact was known and acknowledged, vs. me being blamed for being ill, just because the severity is not recognized, nor given treatment. Cause I've taken the slack for that too (It's called, coming from an uncaring reptilian family [except for my brother, who does know, who was there for a lot of it]).

Thread split to http://forum.psychlinks.ca/post-traumatic-stress-disorder-ptsd/25457-ptsd-resources-in-ottawa.html​

Okay, I went into a tiny rant there, but it is frustrating from my perspective. I did get a social worker who's smart enough and has taught me some flashback management, but I've been sick since 96, total incapacitation by 98, had some ability to study and learn, but totally wrong direction (social work, addictions counsellor-- really bad idea for me-- I thought the courses were cheaper than counselling and I'd have something to show for it and I hoped to become well through it. . . desperation).

I had a flashback in one of the classes, I reacted to a role play exercise, I can't remember the trigger even. I remember the teacher, who was a certified counsellor and with "board certified in the treatment of traumatic stress and effects" (something like that). I told her that I had to leave, and get out of there, that I'm not well. . . she stopped and had me pause, held my my arm, (redirected it a bit, flight fight in me cause tense arms, ready to fight?) but anyway, she assured me that I was safe, and no-one was going to hurt me, I flashed somewhere else and I'm pretty sure a child voice came from me, and she asked me how old I was, and I gave my real chronological age, but it was a child's voice, a three year old. When she assured me I was safe, something clicked in me to go "oh yeah"-- and that ended the distress, though I can't remember what triggered at all. But I didn't have to suffer the whole week in chaos, because it was healed right there on the spot. IT's not total dissociation as in 'alters', because somewhere I'm able to recall, somewhere I'm witnessing it from behind, but not able to act.

This creates a lot of challenges re: dealing with flashbacks and understanding triggers. That Shrwartz (sp?) Model, "The Internal Family Systems", it started to make some sense, without it being brainwashing or convincing me, because I already had had some encounters, and not coerced or implanted by one of those types of 'therapists'. It's helpful to know when parts is present, for functioning out there. I think I have mostly co-consciousness, but there are times I do lose time, there's been times when I have become so disoriented, traumatized and I'll get lost walking down a street, unable to recognize from which direction I came-- and that's really scarey, it's like being a lost 3 year old, the vulnerablity is frightening (and also a deterent for wanting to go out when I know my trauma symptoms are already really bad).

Anyway, I have been super fragmented in a while, the last time was the ODSP stuff. I have had trauma, secondary trauma because of so much difficulty trying to get appropriate help, I developed "white coat" BP thing, the panic was that bad, because I was trying so hard to get help while in crisis states, and a bad GP. . . somethings are better, because where I'm at is a lot better, I've got a decent social worker and a decent GP who's professional, can do proper assessment of symptoms, and so meds monitoring. Theres more big Ts, but this isn't about quantity right now, just talking about the quality of the experiences-- and it's definitely enough, cause I'm noticing I'm starting to feel ill. So I'm going to stop and distract, have a tea, maybe a soak in the tub.

 

[forgetmenot]

i don't think labels will change anything as said it is up to each doctor to look at what is presented in front on them the symptoms and treat that i won't accept a label of anything because i am not that and never will be a label never sorry if this is wrong it is not the label thats matter

 

[CarlaMarie]

My point is not about applying a label to a person. For me it has been about identifying the problem and finding a solution. No judgement. Personally I have found a lot of power in knowing my dyagnosis so I can see and understand what the symptoms are. Then I know what it is. Knowlege is power.
I could not understand my reaction to being loved and nurtured until I read the stuff on Complex Trauma. I cry when I feel love, I cry. Doesn't matter from whom. There hasn't been a psychiatrist, pschologist, therapist, or anyone who has been able to explain it to me so I get it. Emotional flashbacks expain it, neglect and abandonment in relation to my PTSTD expain that to me and I get it.
I reacted to these statements made:

I would argue that the outcome depends very much on the interaction of several factors, including the nature of the trauma, various temperamental and personality characteristics of the victim, and how the individual processes what s/he has experienced. My argument would be against a separate diagnosis for that reason. I think we need to understand that the nature and extent/severity of PTSD is very different from one individual to another, evn where individuals experience and are reacting to the same traumatic event(s).

I say to that well of course you have to treat every person as an individual. That argument doesn't make any sense to me. There were four of us who grew up in that home and I am the only one who has been diagnoised with PTSD. My brother was the first born golden child and the apple of everyones eye, then came my sister who was sweet and complient, and then me. I was willful. I didn't back down (and still can't obviosly) so I got the crap beat out of me. And you know the rest of the story. Does that mean because of my temperment I am prone to trauma?

My point is you either have it or you don't. My siblings weren't effected the same way I was because of the reasons you stated. It felt like judgement.

 

[forgetmenot]

Hi i am sorry you felt judged i do not think anyone meant it that way i just don't like labels because of the way i see people treated that all You find it helps you to know each of us is different that way too i guess.
I am sorry you are feeling not heard but no one wants you to feel judged okay we just are looking at things differently that is all. hugs to you

 

[Cat Dancer]

Is PTSD something you can get rid of eventually? My therapist says you can and I'm wondering if that is the case or is it a lifelong diagnosis?