PTSD vs C-PTSD vs personality disorders...?

[Ecdysis]

I have a relatively new trauma therapist and we're doing a weird mish-mash of treatment while me also trying to get him updated about my entire past history, which at nearly 50 years of age, is a lot.

We're currently dealing with the issue of diagnoses and he said something weird at the end of the last session, that I'm trying to get my head around.

I understood him as saying: PTSD is really only an appropriate diagnosis for "single event" type traumas - for example, experiencing a sexual assault as an adult.

If trauma occurs in childhood and goes on for any length of time (as opposed to a "single event" trauma) then it will *necessarily* affect the child's developing personality so will *always* entail a personality disorder.

This reasoning seems a bit off to me...

I asked whether it wouldn't be C-PTSD then, as oppsed to PTSD, but we agreed it's not an ICD / DSM diagnosis.

It was the end of the session, so no more time for asking for clarification, which I'll have to do at the next appt in 2 weeks time.

It strikes me as very over-generalised tho and I'm not sure I agree.

Also, I have a strong negative reaction to the words "personality disorder" whereas I don't have that kind of reaction to the words "PTSD" or "C-PTSD".

Why is that? Is there a much bigger stigma attached to personality disorders?

Does it sound like an insult to my subconscious if someone says "personality disorder"?

I'm not sure I even truly understand what a personality disorder is vs. what it's not.

I'm not sure about a full list of "all" personality disorders either.

I dunno... As a feminist, I feel a lot of resistance to how easily women are given the lable of a personality disorder in treatment.

I know a good psychiatrist who is very critical of personality disorder diagnoses because he says they're just used to lable people a therapist/ Dr views as "too challenging" for "simple treatments" to work.

I dunno... a lot of questions and a lot of resistance about those kinds of diagnoses being dodgy and wondering whether they're helpful...

Edit to add.... done some googling:

The DSM has 10 personality disorders:
1 paranoid
2 schizoid
3 schizotypal
4 antisocial
5 borderline
6 histrionic
7 narcissistic
8 avoidant
9 dependent
10 obsessive–compulsive

and also "unspecified personality disorder"

They're grouped into 3 clusters:

Cluster A (odd or eccentric disorders)​

Paranoid personality disorder, Schizoid personality disorder, Schizotypal personality disorder

- often associated with schizophrenia
- greater grasp on reality than those with schizophrenia
- can be paranoid
- unwillingness and inability to form and maintain close relationships

Cluster B (emotional or erratic disorders)​

Antisocial personality disorder, Borderline personality disorder, Histrionic personality disorder, Narcissistic personality disorder

- characterized by dramatic, impulsive, self-destructive, emotional behavior

Cluster C (anxious or fearful disorders)​

Avoidant personality disorder, Dependent personality disorder, Obsessive–compulsive personality disorder

- characterized by anxious and fearful behaviours (e.g. perfectionism, dependency, anxiety)

 

[Weemie]

PTSD and CPTSD are interchangeable diagnostically, you can be diagnosed with PTSD if you have complex trauma. The only real difference between CPTSD and a personality disorder is that it is diagnostically considered to be caused by trauma, whereas personality disorders don't feature trauma in their criteria necessarily.

But in my opinion they've simply rebranded personality disorders and make a claim that those symptoms which are already explained by existing disorders somehow cause a new disorder when trauma is involved. It's because personality disorders are highly stigmatized.

But looking at the symptoms it's clearly describing alterations of fixed/stable traits which is in the realm of personality, dissociative and attachment disorders. There's nothing wrong with having a personality disorder and a majority of them also are shown to have trauma as a causative factor.

I wrote more details here.

 

[brokenpony]

I understood him as saying: PTSD is really only an appropriate diagnosis for "single event" type traumas - for example, experiencing a sexual assault as an adult.

i’m not sure i understand what argument he is making or if you misinterpreted but they aren’t diagnoses of exclusion and shouldn’t be treated that way based on his personal pet theories. you can have symptoms of ptsd from developmental trauma and personality disorder traits from developmental trauma at the same time, and therefore both.

 

[Ecdysis]

Hi @Weemie thanks for your feedback and thoughts.

I've been looking at the personality disorders but none of them feel even vaguely "right" to me when I read through the criteria.

I don't know if it's the way I'm reading them, but to me it sounds like each of the PD's listed above sort of "distorts" a person's personality in some particular direction.

Like, you're hyperfocussed on attachment in BPD or avoidant of it in schizoid PD.

You're really "rules" focussed in OC-PD or really anti-social in AS-PD.

It seems to me like a healthy personality has a big mix of "all the traits" where as with a PD, you selectively have some traits very strongly pronounced.

I don't feel like that fits at all for me... For example, I can be both shy/ introverted/ quiet but also extroverted/ social.

I like some order and rules in my life, but not overly much.

Sometimes I'm hyper-avoidant (when I'm in flight/ freeze) or I can be action-oriented, opinionated, pro-active (when I'm in the fight response).

I can overly worry to the point of mild paranoia that "bad things will happen" but I see that as a trauma symptom, that is sometimes present, but not always.

I dunno... these PD's just feel like a big pile of shoes, but none of them fit.

I'd be happy with C-PTSD, if they hurry up and make that a proper diagnosis one of these days.

I'm also wondering what the *proper* diagnosis process is for PD's.

It kinda pisses me off that therapists just think they can "tell" by looking at someone.

I realise, sometimes you can... I've observed ppl too and thought "Ahhh, yes... BPD" or "OMG that person sooo has ADHD"

But that's just guessing... And I don't think that's good enough for therapists...

The times that I've had a PD diagnosis floated as a possibility have all been times when I've been in an acute crisis and dysregulated and symptomatic as f*ck.

Personally, I don't think you can go from what someone's like when they're in crisis and go "this is what they're like all the time".

Hmmm.... grumble, grumble... This topic (PD's) aggrevates me...

 

[Ecdysis]

i’m not sure i understand what argument he is making or if you misinterpreted but they aren’t diagnoses of exclusion and shouldn’t be treated that way based on his personal pet theories. you can have symptoms of ptsd from developmental trauma and personality disorder traits from developmental trauma at the same time, and therefore both.

Yeah, that's how I understand it too... I found his comment weird... I'm going to ask him to do a proper diagnostic process... With the questionaires and the whole proper process... I don't think I want his pet theories to be the yardstick, either.

 

[Ecdysis]

Okay I sent T an email asking him to send me PD diagnostic questionnaires I can fill out and bring to the next appt. Hopefully that will bring some clarity and resolve this issue.

 

[Weemie]

sort of "distorts" a person's personality in some particular direction.

Essentially it's a pervasive pattern of a person's fixed/stable traits (the way they are, most often). "Personality" is a misnomer.

In the ICD-11 there is no more distinction between personality disorders, they are all bridged into one with a couple of modifiers like borderline and dissocial (but the diagnosis is the same). Personally as someone with schizoid I believe schizotypal and schizoid ought to be bridged with schizophrenia under Schizophrenia Spectrum Disorder.

While it does affect my fixed/stable traits my symptoms are largely neurological in nature (in particular anhedonia and avolition, flat/waxy affect etc). My relationships with others are stable (just very low, but my perceptions are fine. I don't split, I don't have abandonment issues, I don't rage out, I understand boundaries, etc). and my social skills are fine.

It's more like schizophrenia than it is like autism or personality disorder. My lack of desire for social interaction is because I don't have the internal impetus/energy to engage with anything. NMDA antagonist medications like DXM actually allow me to have normal interactions.

 

[Weemie]

I'm also wondering what the *proper* diagnosis process is for PD's.

There are inventories you take which is basically just answering questions. Mine included things like "do you obey the law" or "would you lie to get what you want" etc. Mine showed a schizoid-typical pattern of both narcissism and ASPD, but in schizoid it's different. I don't obey the law because I don't give the law any authority. I obey my own moral code. I would lie to get what I want but what I want is peace and quiet. I don't value other opinions but my own but I don't care about convincing anyone else. I am perfectly capable of making and sustaining friendships but I just don't want to. Etc.

 

[brokenpony]

Yeah, that's how I understand it too... I found his comment weird... I'm going to ask him to do a proper diagnostic process... With the questionaires and the whole proper process... I don't think I want his pet theories to be the yardstick, either.

i would also be wary of someone who says that having developmental trauma just automatically means you have a personality disorder. if that’s what he’s saying.

 

[Ecdysis]

i would also be wary of someone who says that having developmental trauma just automatically means you have a personality disorder. if that’s what he’s saying.

Yup. That's what he said. Seemed weird to me too. We're only about 10 sessions in, so I'm still getting to know him and vice-versa. He's also said once that he doesn't really "believe" in diagnoses. I sort of get that, but I'm not sure I agree with that either.

 

[Friday]

PTSD and CPTSD are interchangeable diagnostically, you can be diagnosed with PTSD if you have complex trauma. The only real difference between CPTSD and a personality disorder is that it is diagnostically considered to be caused by trauma, whereas personality disorders don't feature trauma in their criteria necessarily.

But in my opinion they've simply rebranded personality disorders and make a claim that those symptoms which are already explained by existing disorders somehow cause a new disorder when trauma is involved. It's because personality disorders are highly stigmatized.

But looking at the symptoms it's clearly describing alterations of fixed/stable traits which is in the realm of personality, dissociative and attachment disorders. There's nothing wrong with having a personality disorder and a majority of them also are shown to have trauma as a causative factor.

I wrote more details here.

Also...

1. Enduring & Persistent (the necessity of being present from childhood onward) is removed...

- Throwibg WIDE open the doors to combat vets, journalists, aid workers, & civilians, who enter a war one way & leave "a very different person" <<< Which is a HUGE consideration in Europe, with refugees seeking asylum & citizens returning... that North America just doesn't see, except as drops in a bucket, diluted by stable population.
- Allowing for the reactive/cyclic nature of trauma disorders (asymptomatic & symptomatic depending on many different factors, both internal & external).

2. A person can be subthreshold for any/many PD's but still have those traits & tendencies locked in (as @brokenpony "pile of shoes, none of which fit")

3. Enduring personality change after catastrophic experience (EPCACE) <<< Was removed / replaced in the ICD as better described by CPTSD. >>> which is curious because as previously written that *could be* a single event. What researchers found, however? Is that if enduring personality change happened after a "single" event? There was always a history of trauma/complex trauma primed that this "single" event lot the match & exploded all of it. First responders, childhood trauma, DV, whatever. So if someone did present with enduring personality change? Look deeper. It's not 'just' this one thing, but a whole lot more.

 

[Sideways]

PTSD is really only an appropriate diagnosis for "single event" type traumas

I simply don’t understand this statement. Especially coming from a treatment perspective, where it is very clear that many people live in persistently abusive situations without going on to develop all the nuances of pathological disorder associated with complex ptsd.

*necessarily* affect the child's developing personality so will *always* entail a personality disorder.

Yes, it necessarily affects a developing personality.

Most things that affect our developing personality do not cause a personality disorder.

I asked whether it wouldn't be C-PTSD then, as oppsed to PTSD

There are differences between complex-PTSD and BPD. But complex ptsd is only 30 years old as a concept - it’s unlikely it’s simply a replacement for BPD, but there is also a lot of overlap.

That’s helpful for treatment. Because DBT is crazy helpful for a lot of symptoms associated with BPD which overlap with complex PTSD, so even without BPD, DBT can be incredibly helpful.

there a much bigger stigma attached to personality disorders?

Yes, and BPD in particular. Most problematically from within the medical community itself - for example, there’s been research about just how much less support a person will get if they present to an ED with BPD ad opposed to other types of mental illness, as well as the different ways they will be treated by medical staff if they have that diagnosis.

There’s currently a push to rename BPD ‘Emotionally Unstable Personality Disorder’ - partly to help undermine some of that stigma (but also to apply a more accurate name).

To help overcome that? Think of it as Condition B. As in I have Condition A (PTSD) and we’re looking at whether I may also have Condition B.

Personality assessments are helpful - even if your symptoms don’t rise to the level of an actual disorder (which is very often the case). They help us identify the parts that are problematic and can be targeted with treatment.

For example, when I went through a period of diagnostic investigation and reinvestigation to figure out what was going on for me, the personality assessments indicated I had symptoms of a particular type of Narcissistic PD (yeah - you reckon BPD comes with stigma, imagine being told you may have NPD! The horror!).

Once I got over the horror of that (!!), it was actually immensely helpful. Because what they’d actually identified was I had delusions that were the opposite of, but equally as dysfunctional as, delusions of grandeur (I genuinely believed my mere presence could make good men do bad things).

That belief wasn’t just the logical consequence of my trauma and massive self-loathing issues, it was actually delusional and narcissistic. That helped me tackle it in a really productive way.

Personality disorders are full of symptoms that are typical of even healthy folks - just not to the extent that they appear in PDs.

I don’t have NPD. Just like you likely don’t have Condition B. That doesn’t mean that assessing your personality is a waste of time. To the contrary, anything that helps you understand yourself, what’s going on and why, is helpful to recovery. Take the insight part, dump the stigma part.