Why Complex PTSD Should Remain A Fictional Diagnosis
75Because when we all need the same for the same reason, why separate us?
Some therapists are diagnosing people with a fictional mental illness called Complex PTSD. The diagnosis, or dare I say misdiagnosis, of complex PTSD is not included in the Diagnostic and Statistical Manual (DSM) by the American Psychiatric Association. I seriously hope it is never included as an official diagnosis.
Complex PTSD is a diagnosis that someone made up to categorize people with PTSD due to long-term abuse during which the person had little to no control for an extended period of time. Examples of this type of situation are being held hostage in a POW camp, being kidnapped and forced into the sex trade, or long-term or ritualistic child sexual abuse.
Am I saying that people who have experienced those conditions should not be diagnosed with PTSD or that those experiences aren’t absolutely horrific? I’m not saying that at all. If the person is experiencing symptoms of PTSD due to a trauma, they should definitely be diagnosed with PTSD.
My issue with the diagnosis of complex PTSD is that it does no good. I have only seen it cause division among people with PTSD and confusion for those who are diagnosed with it. Why is it necessary?
For it to be a necessary diagnosis, I would expect the symptoms to be different than a regular PTSD diagnosis. The problem is that the symptoms are no different. A person with PTSD from any trauma can experience the exact same symptoms as someone with “complex PTSD.”
Symptoms of Complex PTSD:
· Alterations in Emotional Regulation
· Alterations in Consciousness such as Flashbacks and Forgetting Part of the Trauma
· Changes in Self-esteem and the Person’s Self-concept
· Altering Perception of the Perpetrator
· Sense of Hopelessness or Loss of Faith
· Changes in Personal Relationships
· Avoiding Discussing the Trauma
· Self-harm
· Unhealthy Coping Methods to Numb the Feelings like Drinking or Drug Use
Every single one of those symptoms is common in anyone with PTSD, whether the PTSD was caused by being in a concentration camp or ongoing child sexual abuse as complex PTSD describes or if the trauma was a single event. So, what is the purpose of the diagnosis? So far, the only thing that I have seen it do is make people who are diagnosed with PTSD feel as though their experiences with the disorder are being belittled. If there is a complex PTSD, it is implied that regular PTSD is Simple PTSD. There is nothing simple about PTSD.
Some proponents of a diagnosis of complex PTSD have supported their views by saying that complex PTSD is different, because the victim is often blamed or considered to have a personal weakness for either the abuse or developing PTSD. How is that different from a rape victim who has PTSD and is blamed for the assault? Many, many people with PTSD are blamed for either the trauma or for developing the PTSD. I think these professionals are out of touch with what it is like to live with PTSD and lose friends over it. It’s happened to me and is quite common with people with PTSD.
Personally, if I went to a therapist and the therapist gave me a fictional diagnosis, I’d get up and walk out. I’d think it was time to look for a new therapist.
What does categorizing PTSD do? Has it led to new treatments? Not that I am aware of. Has it led to the development of new medication for PTSD? No. Has it confused people who are diagnosed with the condition? Well, yes, it has done a good job of that. Does it cause division among people with PTSD and Complex PTSD diagnoses? Certainly. One only has to look at a PTSD forum to see arguments about the Complex PTSD diagnosis.
If we are going to start categorizing PTSD, where does it end? Should we have Combat PTSD, 9/11 PTSD, Rape PTSD, Domestic Violence PTSD, Car Accident PTSD, etc? There could literally be hundreds of causes of PTSD. Complex PTSD, PTSD, and all the other categories based on causes of PTSD can cause the exact same symptoms of PTSD, so if we are going to separate Complex PTSD, why not have separate categories for each? Yes, that’s silly, and so is having a diagnosis of Complex PTSD.
PrintShare it! — Rate it: up down flag this hub
Comments
Interesting argument. I really like Judith Herman's book Trauma and Recovery, in which she argues in favor of the complex PTSD diagnosis as a replacement for borderline personality disorder and other diagnostic labels with similar symptoms that can be stigmatizing to women. I don't think she anticipated that people diagnosed with "simple PTSD" might feel belittled as a consequence, but that's a good point. All trauma is complex, and I agree with you that all of us with PTSD have a great deal in common with each other no matter what the type, duration or source of our individual traumas.
Complex PTSD is a legitimately different disorder than regular PTSD. Just because symptoms of the two disorders *can* overlap doesn't mean that the labels are synonomous.
Like pulling a tablecloth out from under a table full of dishes, speed matters. Quick, acute traumas shock the physiology and make it go haywire. Slow, moderate traumas habituate the physiology to new baselines, slowly eroding its resilience.
Simple PTSD is a third degree burn.
Complex PTSD is heatstroke.
Simple PTSD is an internal conflict. Half of you is trying to remember and half of you is trying to forget.
Complex PTSD is an internal defeat. All of you is trying to forget.
Neither disorder is worse or more severe than the other. They're just different. And the more specifically we classify them, the more effectively we can treat them.
I don't believe that people who suffer from "simple" PTSD have more inner conflict than someone with "complex PTSD." Someone who was raped by a stranger may be diagnosed with PTSD and have no desire to remember the parts of the trauma that they cannot. However, someone with "complex PTSD" who was repeatedly sexually abused by their father may have a tremendous amount of internal conflict due to the love for their father.
One of the main issues I have with this fictional diagnosis is well illustrated in your comment. If one is "complex," the other is "simple." This implication does nothing but belittle people's struggles with "simple" PTSD.
Several different causes of PTSD can have slightly different symptoms. A person with PTSD from a horrific car accident can develop a phobia of driving. Rape-trauma PTSD can cause severe damage to the person's self-esteem and sense of safety and security. Should we separate all of these types of PTSD and others?
I understand your point about "simple" vs. "complex." But we can choose more sensitive names for them while still recognizing that they're distinct.
The main reason I think the latter type needs it's own category is for facilitating diagnosis in people who may not realize that their symptoms are related to PTSD. The former type of PTSD is discussed in the mainstream press everywhere. If you were raped or in a horrific car accident or witnessed a murder or survived 9/11 and you're having nightmares or phobias or depression or thoughts about self-harm, it likely occurs to you (and to any therapist you may see) "These symptoms may be a result of that trauma. This may be PTSD." If you spent years in the midst of a long, slow-burning trauma that contained elements of joy and pride and belonging mixed in with the trauma and you're now having nightmares or phobias or depression or thoughts about self-harm, it may not occur to you that the symptoms are even connected to each other, much less to your past.
My first diagnosis was ADHD and depression. My physiology had been slowly worn down (over 10 years) and eventually even the strategies I'd been using to compensate (channeling my negative emotions into working hard in school) gave out, and my concentration was so shot I couldn't read fast enough to finish exams on time. I went from Valedictorian of my high school to flunking out of college. The shrinks all looked for what had *changed*, what was *different*, what the *catalyst* was. My long-standing hyperarousal, my gradually increasing impairments in concentration, and my new difficulties with depression (all of a sudden, my crying became uncontrollable--if I started I couldn't stop) were treated as seperate, unrelated sets of symptoms.
When I later read Trauma & Recovery, I identified strongly with the chapter entitled "Captivity." I realized (duh!)that my various symptoms were connected, and rather than having a specific catalyst, they were caused by overall burnout. Because I had adjusted so *well* to my captivity (in the sense of accepting the hand I was dealt and learning and adapting to the rules, not in the sense of stockholm syndrome) and because I earned my way out with a scholarship, I didn't perceive my past to be a traumatic influence powerful enough to affect my present, and there were apparently no flags to motivate the shrinks to investigate further. I had to figure out on my own that my symptoms were a form of PTSD.
Figuring it out helped me seek out and find much more effective treatment.
So... Obviously I support efforts to get psychologists to recognize that people can get PTSD from long-term moderate stressors. I personally have no problem with the simple vs. complex distinction, but if people find the term "simple" insulting, I think the problem could be solved by naming them differently or by broadening the definition of PTSD to include sub-types.
All I'm saying is that I think it's useful and important to recognize that there are different types of PTSD. Just as you find it insulting when a struggle that affects every minute of your day is called "simple," I find it insulting when a diagnosis that saved my life is called "fictional." I don't think this has to be an either-or conflict. I think there's room for both of us.
My label of complex PTSD as fictional is merely an objective fact, not meant to belittle anyone's experience with PTSD. If it is not in the DSM, it is not an official diagnosis. If person is in the United States, has been diagnosed with "complex PTSD," and pays for mental health services with insurance, I can pretty much guarantee that person's diagnosis listed on their medical forms is PTSD or simply 309.81, the diagnostic code for PTSD. Otherwise, insurance wouldn't pay the claim.
You make a good point about mental health professionals lacking in knowledge of how different causes of PTSD may manifest themselves. I just don't think that dividing the group and causing conflict and confusion is the answer. Many different traumas that lead PTSD cause different symptoms. Educating mental health professionals about these different symptoms without making numerous divisions of the diagnosis would be ideal.
Having worked with many traumatized individuals, I believe there is some benefit in the concept of complex PTSD. One of the problems we face is that PTSD is categorized as an anxiety disorder including re-experiencing, avoidance/numbing, and arousal symptoms. There are effective Cognitive Behavioral Treatments for PTSD. It does not make sense to argue that because one is referred to as complex PTSD the other must be simple PTSD. The difference is in how you understand the development and the treatment of the problems. PTSD is extremely distressing and no one should doubt that. However, when treating PTSD it is often possible to identify one external event that lead to the disorder. We can then work with a person to resolve their symptoms – as complex as those symptoms may be for any given individual. For example, those diagnosed with PTSD often have diagnoses of depression as well or suicidal/self injurious behaviors. The difference is that these are not required for a diagnosis of PTSD. One solution is to give a person a diagnosis of PTSD and then add multiple other diagnoses to capture the other problems. This is what you would do for billing purposes, but I think it misses the point. The benefit of the concept of complex PTSD is that it attempts to explain how prolonged or chronic exposure to traumatic events, neglect, or other stressors changes a person’s ability to regulate emotions, relate to others, etc. Where processing a horrific rape or car accident is extremely difficult for patients, it is possible to help patients gradually reduce their anxiety and PTSD symptoms through repeated exposure to that traumatic event. Once the anxiety symptoms have improved, it is then possible to work with all of the shame, guilt, and other emotions that can be brought about by a traumatic event. In the case of complex PTSD, it is often difficult to pinpoint one traumatic event and the work is less about reducing anxiety (although this can be one important part of the treatment). There are specific treatments for complex PTSD that have been researched and seem to be effective. These are treatments that tend to have more components than the treatment of PTSD. I am not sure that claiming one disorder is more complex, troubling, or severe than any other is useful. I have seen people devastated by many disorders. The other thing to keep in mind is that having a DSM code or a diagnosis that is accepted by your insurance does not make it a more legitimate diagnosis. Having research to support to utility of a separate diagnosis and the effectiveness of treatments is what is needed.
OpPTSD_Jason says:
2 months ago
I agree with you on the division of PTSD diagnosis. This problem has enough complexity. I would like to see a more focused effort made toward research of successful treatments for the "original PTSD." I am quite tired of the old school therapists insisting that meds and talk therapy are the answer while downing NLP as psuedo science. I am of the belief that whatever works is the right answer for each individual. I also think that the patient has a tremendous impact on his/her own outcome based upon belief of its effectiveness.