# Complex PTSD includes DP as symptom



## Emir (Nov 20, 2010)

Not sure if this has been posted before but there is a subtype of PTSD called complex-PTSD which can contribute to DP and which results from a prolonged environment of stress/abuse/violence.

*Child and adolescent symptom cluster*
Dissociation - "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"

from: http://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder


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## pancake (Nov 26, 2009)

j4mtj said:


> Not sure if this has been posted before but there is a subtype of PTSD called complex-PTSD which can contribute to DP and which results from a prolonged environment of stress/abuse/violence.
> 
> *Child and adolescent symptom cluster*
> Dissociation - "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"
> ...


There used to be quite a few people with this diagnoses on the board last year.


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## Emir (Nov 20, 2010)

pancake said:


> There used to be quite a few people with this diagnoses on the board last year.


Aha, interesting, I've never heard of Complex-PTSD before but good that they now have a subtype which includes our experience.


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## pancake (Nov 26, 2009)

I asked this in my previous post and then deleted it thinking the question was stupid, now one google search later I have to ask after all: Is complex PTSD just a different flavour for DID/MPD or are there actually any differences other than the extra criteria of difficulty forming attachments? Just wondering in case anyone here knows.

also I missed this bit in the wiki article earlier but the diagnosis is not currently in the DSM


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## Guest (Jan 19, 2011)

The problem with this diagnosis is:

1. Articles have been written on it but it is not included in the DSM. Not sure if it is included in the ICD, have to look
2. There is some confusion if it is some variation of Borderline Personality, which is also thought to be connected in some way to DID.

I personally, having been abused might fit the diagnosis, MAYBE, however, not.

I will try to find the medical articles they refer to on this. The diagnosis, in my recent research, is under debate.

Also, 
I'm learning the difference between Acute Stress Disorder vs. PTSD. Both are different, but one can have the first and later have the second.

It's a question of mixing together a number of disorders under one umbrella.


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## Guest (Jan 19, 2011)

Differential diagnosis for PTSD IN CHILDREN is Adjustment Disorder of Childhood. A psychoanalyst gave me that diagnosis once when I was 40ish.

Types of PTSD:
1. Acute
2. Chronic

Subgroup: onset delayed

Complex PTSD seems to be in the realm of those studying trauma in a more psychoanalytic way.

2011 Article

http://www.ncbi.nlm.nih.gov/pubmed/21240739

*J Trauma Dissociation. 2011 Jan;12(1):67-87.
Predicting stabilizing treatment outcomes for complex posttraumatic stress disorder and dissociative identity disorder: an expertise-based prognostic model.*

_*Baars EW, van der Hart O, Nijenhuis ER, Chu JA, Glas G, Draijer N.
Louis Bolk Instituut, Driebergen, The Netherlands.*_

Abstract

The purpose of this study was to develop an expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID).

We developed a survey in 2 rounds: In the first round we surveyed 42 experienced therapists (22 DID and 20 complex PTSD therapists), and in the second round we surveyed a subset of 22 of the 42 therapists (13 DID and 9 complex PTSD therapists).

First, we drew on therapists' knowledge of prognostic factors for stabilization-oriented treatment of complex PTSD and DID. Second, therapists prioritized a list of prognostic factors by estimating the size of each variable's prognostic effect; we clustered these factors according to content and named the clusters. Next, concept mapping methodology and statistical analyses (including principal components analyses) were used to transform individual judgments into weighted group judgments for clusters of items.

*A prognostic model, based on consensually determined estimates of effect sizes, of 8 clusters containing 51 factors for both complex PTSD and DID was formed.*

It includes the clusters lack of motivation, lack of healthy relationships, lack of healthy therapeutic relationships, lack of other internal and external resources, serious Axis I comorbidity, serious Axis II comorbidity, poor attachment, and self-destruction.

In addition, a set of 5 DID-specific items was constructed. The model is supportive of the current phase-oriented treatment model, emphasizing the strengthening of the therapeutic relationship and the patient's resources in the initial stabilization phase. *Further research is needed to test the model's statistical and clinical validity.*

PMID: 21240739 [PubMed - in process]

---------------------------------------

_*As noted it is sort of putting DID and Borderline Personality in one new diagnostic criteria which I don't find helpful as DID may indeed be a PART of BPD. This is in dispute. This is a working model. This is closer to research into abuse trauma than the physical life-threatening trauma of PTSD which is associated with war, attack on life, rape, etc.

I just reread this for the third time. It is not a useful article as it is based on a survey of THERAPISTS who treat DID and PTSD. Not even of patients.*_


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## Guest (Jan 19, 2011)

*"It includes the clusters lack of motivation, lack of healthy relationships, lack of healthy therapeutic relationships, lack of other internal and external resources, serious Axis I comorbidity, serious Axis II comorbidity, poor attachment, and self-destruction."*

All of these can attributed to Borderline Personality Disorder, and really not specifically to PTSD. (There is also another term for that in debate called Mood Dysregulation Disorder).

I'm curious who has received an official diagnosis of this as the diagnosis doesn't exist, to the best of my knowledge in the US, for coding purposes. I'll ask my therapist on Thursday.

The bias on this diagnostic process comes again from a more psychoanalytically based community. I'd gather this is discussed on the ISSD-T website (originally the ISSMPD, and now MPD has now been changed to DID).


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## Emir (Nov 20, 2010)

You rock and roll, Dreamer! Thanks for this.

I do think that complex-pstd vs pstd uniquely describes the environment that can give rise to psychiatric disorders that certainly overlap in symptomology (sp?).

_*Complex post-traumatic stress disorder (C-PTSD) is a psychological injury that results from protracted exposure to prolonged social and/or interpersonal trauma with lack or loss of control, disempowerment, and in the context of either captivity or entrapment, i.e. the lack of a viable escape route for the victim. *_

Whether it meets the full criteria for inclusion in DSM, I will leave to the experts, but I guess I'm struck by Herman's work in acknowledging the reality of what many people have lived with, with disastrous consequences.


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## Guest (Jan 19, 2011)

j4mtj said:


> You rock and roll, Dreamer! Thanks for this.
> 
> I do think that complex-pstd vs pstd uniquely describes the environment that can give rise to psychiatric disorders that certainly overlap in symptomology (sp?).
> 
> ...










Sometimes I rock, then fall over, LOL. YOU are spot on here, couldn't say it better. I can say that the definition as posted above is my life! And yes, the consequences are not pretty. I would say, yes, if you wish to call it that, I had chronic stress, abuse, "entrapment" as a child as I depended on my mother who was my abuser. Every word applies to my life.

Intersting is, I do not have DID, and I do not have BPD. But we do know that trauma factors in, in BPD, and DID.
But I have many qualities in my personality that clearly reflect a horribly negative way of thinking about myself, the world, hopelessness, etc.

Well, you said it all.


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## pancake (Nov 26, 2009)

j4mtj said:


> You rock and roll, Dreamer! Thanks for this.


Second that


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## Paige (Apr 27, 2011)

I haven't been diagnosed with C-PTSD as it's not a diagnosis yet, however I have spoken about it with my doc and if it was in the DSM, I'd certainly have it. As a side note I also have MDD, PTSD, and DID but do not fit enough criteria for borderline, although I certainly have some symptoms. Take that as you will.

My idea of C-PTSD is basically PTSD that is pervasive and chronic, usually involves other Axis I and/or IIs, and involves multiple traumas for extended periods of time. In my experience the people I have met with obvious chronic PTSD issues have all been through heavy duty trauma usually involving some kind of captivity or totalitarian situation (like being a POW). I personally was kidnapped by a sexual predator for several years as a teenager, and had heavy inter-family abuse before then. j4mtj's got it.


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## kate_edwin (Aug 9, 2009)

complex ptsd i more of a syndrome, a long term, caused by more then one incident kind of thing

did and dissociative disorders are not on the same spectrum as any ptsd. ptsd *can* have dissociative symptoms, so can anxiety disorders and depression

there are many many people with did and other dissociative disorders who do in fact not meet the criteria for ptsd


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